Healthcare Provider Details

I. General information

NPI: 1881427219
Provider Name (Legal Business Name): CHIBUZO IKENNA ANYAKORA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 PUTNAM RD
RALEIGH NC
27610-6945
US

IV. Provider business mailing address

3712 PUTNAM RD
RALEIGH NC
27610-6945
US

V. Phone/Fax

Practice location:
  • Phone: 240-716-4336
  • Fax:
Mailing address:
  • Phone: 240-716-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: