Provider Demographics
NPI:1841781804
Name:ANYAEGBU, IHEOMA EDORO
Entity Type:Individual
Prefix:
First Name:IHEOMA
Middle Name:EDORO
Last Name:ANYAEGBU
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 1:4701 14TH ST APT 11305
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-7321
Mailing Address - Country:US
Mailing Address - Phone:214-607-5411
Mailing Address - Fax:
Practice Address - Street 1:4701 14TH ST APT 11305
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-7321
Practice Address - Country:US
Practice Address - Phone:214-607-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215917164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse