Provider Demographics
NPI:1811402811
Name:IKEGULU, ANTHONIA ONYINYE
Entity Type:Individual
Prefix:MRS
First Name:ANTHONIA
Middle Name:ONYINYE
Last Name:IKEGULU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15006 BROOKWOOD BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2140
Mailing Address - Country:US
Mailing Address - Phone:281-983-0009
Mailing Address - Fax:281-983-0009
Practice Address - Street 1:15006 BROOKWOOD BRIDGE LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-2140
Practice Address - Country:US
Practice Address - Phone:281-983-0009
Practice Address - Fax:281-983-0009
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator