Provider Demographics
NPI:1962036442
Name:ANENE, ISICHEI SAMUEL
Entity Type:Individual
Prefix:
First Name:ISICHEI
Middle Name:SAMUEL
Last Name:ANENE
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 1:104 INDUSTRIAL BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3170
Mailing Address - Country:US
Mailing Address - Phone:907-351-4814
Mailing Address - Fax:
Practice Address - Street 1:104 INDUSTRIAL BLVD STE D
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3170
Practice Address - Country:US
Practice Address - Phone:907-351-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver