Provider Demographics
NPI:1881218865
Name:ANYIMADU, MARY ENYONAM (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ENYONAM
Last Name:ANYIMADU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3874 ALBERS PLACE CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-1055
Mailing Address - Country:US
Mailing Address - Phone:484-264-9296
Mailing Address - Fax:
Practice Address - Street 1:3874 ALBERS PLACE CT
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-1055
Practice Address - Country:US
Practice Address - Phone:484-264-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018033943163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health