Healthcare Provider Details

I. General information

NPI: 1184249393
Provider Name (Legal Business Name): ADAKU ANIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N QUINCY ST
ARLINGTON VA
22203-2136
US

IV. Provider business mailing address

718 CARNEROS CIR
HIGH POINT NC
27265-9485
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-0703
  • Fax:
Mailing address:
  • Phone: 336-254-4619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024181482
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5013273
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: