Healthcare Provider Details

I. General information

NPI: 1144245960
Provider Name (Legal Business Name): NWANDO AUDREY ANYAOKU MBBS, MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 30TH ST
OMAHA NE
68131-2128
US

IV. Provider business mailing address

PO BOX 642117
OMAHA NE
68164-8117
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-0909
  • Fax: 402-717-6069
Mailing address:
  • Phone: 402-398-6254
  • Fax: 402-829-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA70905
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28227
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: