Healthcare Provider Details

I. General information

NPI: 1497692578
Provider Name (Legal Business Name): ANVCTORIA ANYANWU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AV ANYANWU

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 REX LAKE RD
LEEDS AL
35094
US

IV. Provider business mailing address

350 REX LAKE RD
LEEDS AL
35094
US

V. Phone/Fax

Practice location:
  • Phone: 312-965-2997
  • Fax:
Mailing address:
  • Phone: 312-965-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: