Provider Demographics
NPI:1437774122
Name:NWANNA-NZEWUNWA, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:NWANNA-NZEWUNWA
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 1:526 E PLEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4002
Mailing Address - Country:US
Mailing Address - Phone:972-223-4420
Mailing Address - Fax:972-274-1167
Practice Address - Street 1:526 E PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4002
Practice Address - Country:US
Practice Address - Phone:972-223-4420
Practice Address - Fax:972-274-1167
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU8105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine