Provider Demographics
NPI:1629379227
Name:HANNAH AMAEFULA
Entity Type:Organization
Organization Name:HANNAH AMAEFULA
Other - Org Name:ANNSON MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAEFULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-602-1641
Mailing Address - Street 1:2306 OAK LN STE 4
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-8819
Mailing Address - Country:US
Mailing Address - Phone:972-602-1641
Mailing Address - Fax:972-325-2238
Practice Address - Street 1:2306 OAK LN STE 4
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8819
Practice Address - Country:US
Practice Address - Phone:972-602-1641
Practice Address - Fax:972-325-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0068058332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies