Provider Demographics
NPI:1013786060
Name:ANUFORO, IVANA CHINONSO (RN/ LPN)
Entity Type:Individual
Prefix:MISS
First Name:IVANA
Middle Name:CHINONSO
Last Name:ANUFORO
Suffix:
Gender:F
Credentials:RN/ LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 YALE AVE UNIT 109
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-4348
Mailing Address - Country:US
Mailing Address - Phone:508-514-0265
Mailing Address - Fax:
Practice Address - Street 1:1078 SUMMIT AVE UNIT 308
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3438
Practice Address - Country:US
Practice Address - Phone:508-514-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP08174400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse