Provider Demographics
NPI:1821697095
Name:ONYEANULA, ANDREW ONYEMAECHI
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ONYEMAECHI
Last Name:ONYEANULA
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 1:8281 WOODCREST DR APT 2
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1238
Mailing Address - Country:US
Mailing Address - Phone:734-620-4959
Mailing Address - Fax:
Practice Address - Street 1:8281 WOODCREST DR APT 2
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1238
Practice Address - Country:US
Practice Address - Phone:734-620-4959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703120577164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse