Provider Demographics
NPI:1609470228
Name:ANUOLAM, CHIMA ZELOTES
Entity Type:Individual
Prefix:
First Name:CHIMA
Middle Name:ZELOTES
Last Name:ANUOLAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 GREENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6242
Mailing Address - Country:US
Mailing Address - Phone:214-772-0295
Mailing Address - Fax:
Practice Address - Street 1:815 GREENRIDGE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-6242
Practice Address - Country:US
Practice Address - Phone:214-772-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331910164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse