MEDICARE: NDIDIAMAKA GLORY ANUGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	1084851	TX

General Provider Information

NPI Number	:	1114755808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NDIDIAMAKA GLORY ANUGO

Provider Business Mailing Address
First Line	:	23410 BAKER HILL DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2567
Country	:	US
Telephone Number	:	516-808-8081
Fax Number	:

Provider Business Practice Location Address
First Line	:	23410 BAKER HILL DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2567
Country	:	US
Telephone Number	:	516-808-2680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	07/24/2024

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Directions to “ NDIDIAMAKA GLORY ANUGO ” Practice Location

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