Healthcare Provider Details

I. General information

NPI: 1154701746
Provider Name (Legal Business Name): NKEIRU P ANYANWU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 N STATE HIGHWAY 161 STE 100
IRVING TX
75038-2239
US

IV. Provider business mailing address

6706 LAKE JACKSON DR
ARLINGTON TX
76002-4048
US

V. Phone/Fax

Practice location:
  • Phone: 469-200-3272
  • Fax:
Mailing address:
  • Phone: 817-501-3654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number833979
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN141396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: