Provider Demographics
NPI:1205585841
Name:ANI, NKEM (NP)
Entity type:Individual
Prefix:MRS
First Name:NKEM
Middle Name:
Last Name:ANI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 GRACE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3229
Mailing Address - Country:US
Mailing Address - Phone:718-219-9218
Mailing Address - Fax:
Practice Address - Street 1:3006 GRACE AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3229
Practice Address - Country:US
Practice Address - Phone:347-416-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY815708163WP0808X
NY405971363LP0808X
NJ26NJ15072400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY815708OtherRN LICENSE