Provider Demographics
NPI:1952637795
Name:ANUKAM, DORIS R (APRN)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:R
Last Name:ANUKAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6190 MAE ANNE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-4709
Mailing Address - Country:US
Mailing Address - Phone:775-418-5990
Mailing Address - Fax:775-418-5991
Practice Address - Street 1:6190 MAE ANNE AVE STE 1
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-4709
Practice Address - Country:US
Practice Address - Phone:775-418-5990
Practice Address - Fax:775-418-5991
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV841181363LP0808X
NV25039163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV25039OtherREGISTERED NURSE
NV841181OtherAPRN-CNP