Provider Demographics
NPI:1407223431
Name:ANZIKENGNZEM, DILYS
Entity Type:Individual
Prefix:MS
First Name:DILYS
Middle Name:
Last Name:ANZIKENGNZEM
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 1:15610 PASSAIE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1442
Mailing Address - Country:US
Mailing Address - Phone:240-646-6166
Mailing Address - Fax:
Practice Address - Street 1:15610 PASSAIE LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1443
Practice Address - Country:US
Practice Address - Phone:240-646-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1004558164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse