Provider Demographics
NPI:1568052645
Name:ANIKWE, BONAVENTURE NWABUEZE (FNP)
Entity Type:Individual
Prefix:
First Name:BONAVENTURE
Middle Name:NWABUEZE
Last Name:ANIKWE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5229 CATSPAW DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4859
Mailing Address - Country:US
Mailing Address - Phone:615-275-5930
Mailing Address - Fax:
Practice Address - Street 1:5229 CATSPAW DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-4859
Practice Address - Country:US
Practice Address - Phone:615-275-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty