Provider Demographics
NPI:1720568132
Name:ANICHE, EBERECHUKWU OLIVIA (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:EBERECHUKWU
Middle Name:OLIVIA
Last Name:ANICHE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:EBERECHUKWU
Other - Middle Name:OLIVIA
Other - Last Name:UFERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2315 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-703-4496
Mailing Address - Fax:916-734-7411
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-703-4496
Practice Address - Fax:916-703-7411
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60890201363LA2100X
CA95022663363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1720568132Medicaid