Provider Demographics
NPI:1487009254
Name:WANJIKU, ANNE (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:WANJIKU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 MONROE ST
Mailing Address - Street 2:BLDG E SUITE 4
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2263
Mailing Address - Country:US
Mailing Address - Phone:419-824-5063
Mailing Address - Fax:419-824-0216
Practice Address - Street 1:5592 BROADVIEW RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-7811
Practice Address - Country:US
Practice Address - Phone:216-741-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF1015426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily