Provider Demographics
NPI:1346645470
Name:IWELUNMOR, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:IWELUNMOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28850 LANCASTER ST APT 32
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3835
Mailing Address - Country:US
Mailing Address - Phone:248-826-8025
Mailing Address - Fax:
Practice Address - Street 1:28850 LANCASTER ST APT 32
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3835
Practice Address - Country:US
Practice Address - Phone:248-826-8025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703114204164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse