Provider Demographics
NPI:1336913680
Name:ANI, AUGUSTINE ONYEKACHI (NA)
Entity Type:Individual
Prefix:MR
First Name:AUGUSTINE
Middle Name:ONYEKACHI
Last Name:ANI
Suffix:
Gender:M
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8861 KILBIRNIE TER
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1930
Mailing Address - Country:US
Mailing Address - Phone:185-723-3101
Mailing Address - Fax:
Practice Address - Street 1:8861 KILBIRNIE TER
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1930
Practice Address - Country:US
Practice Address - Phone:185-723-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2513633163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse