Provider Demographics
NPI:1184288045
Name:OBUMNEME-AKANEME, IFEOMA ERICA
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:ERICA
Last Name:OBUMNEME-AKANEME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 E 224TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-5835
Mailing Address - Country:US
Mailing Address - Phone:718-219-1703
Mailing Address - Fax:
Practice Address - Street 1:153 STEVENS AVE STE 4
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2543
Practice Address - Country:US
Practice Address - Phone:718-219-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344321-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily