Healthcare Provider Details

I. General information

NPI: 1205585841
Provider Name (Legal Business Name): NKEM ANI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 GRACE AVENUE
BRONX NY
10469-3229
US

IV. Provider business mailing address

3006 GRACE AVENUE
BRONX NY
10469-3229
US

V. Phone/Fax

Practice location:
  • Phone: 347-416-8683
  • Fax:
Mailing address:
  • Phone: 718-219-9218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number815708
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number405971
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15072400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: