Healthcare Provider Details

I. General information

NPI: 1326978297
Provider Name (Legal Business Name): AMANDA IJEOMA ANITUBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 WASHINGTON ST
NORWELL MA
02061-2010
US

IV. Provider business mailing address

475 UNION ST
ROCKLAND MA
02370-1732
US

V. Phone/Fax

Practice location:
  • Phone: 781-871-6650
  • Fax:
Mailing address:
  • Phone: 781-267-1865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN2297719
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: