Healthcare Provider Details

I. General information

NPI: 1962368043
Provider Name (Legal Business Name): CHIBUEZE ANYASOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10639 WHITEJACKET
CONROE TX
77385-1437
US

IV. Provider business mailing address

10639 WHITEJACKET
CONROE TX
77385-1437
US

V. Phone/Fax

Practice location:
  • Phone: 932-955-6094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: