Provider Demographics
NPI:1457135626
Name:ANIZOR, NKEMDILIM (RN)
Entity Type:Individual
Prefix:
First Name:NKEMDILIM
Middle Name:
Last Name:ANIZOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NKEM
Other - Middle Name:
Other - Last Name:ANIZOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4527 HUFF PARK CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-2724
Mailing Address - Country:US
Mailing Address - Phone:678-308-4016
Mailing Address - Fax:
Practice Address - Street 1:4527 HUFF PARK CT
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-2724
Practice Address - Country:US
Practice Address - Phone:678-308-4016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268996163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse