Provider Demographics
NPI:1780285130
Name:ANYIWO, CHINONSO JONATHAN
Entity type:Individual
Prefix:
First Name:CHINONSO
Middle Name:JONATHAN
Last Name:ANYIWO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SERENITY DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3182
Mailing Address - Country:US
Mailing Address - Phone:214-517-2739
Mailing Address - Fax:
Practice Address - Street 1:804 SERENITY DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3182
Practice Address - Country:US
Practice Address - Phone:214-517-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015916164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse