Provider Demographics
NPI:1831593540
Name:ANU, SOLAMIC INKENG
Entity type:Individual
Prefix:
First Name:SOLAMIC
Middle Name:INKENG
Last Name:ANU
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 1:5603 LITTLE BEN CIR APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-3087
Mailing Address - Country:US
Mailing Address - Phone:614-377-8528
Mailing Address - Fax:
Practice Address - Street 1:5603 LITTLE BEN CIRCLE APTT B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231
Practice Address - Country:US
Practice Address - Phone:614-377-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP51843164W00000X
OHPN.158170164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse