Provider Demographics
NPI:1962863233
Name:ANOSIKE, IFESINACHI (CRNA)
Entity Type:Individual
Prefix:MR
First Name:IFESINACHI
Middle Name:
Last Name:ANOSIKE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 VILLAGE MARKET BLVD SE
Mailing Address - Street 2:APT 210
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-5109
Mailing Address - Country:US
Mailing Address - Phone:917-459-1158
Mailing Address - Fax:
Practice Address - Street 1:1500 BALCH DR S
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4701
Practice Address - Country:US
Practice Address - Phone:917-459-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173481367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered