Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1020418 | TX |
NPI | 1013507276 |
---|---|
Provider Name | Kennedy Ogbonna Anyanwu |
First Address | Sugar Land, TX 77478-1406 |
Second Address | Sugar Land, TX 77478-1406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2021 |
Last Update Date | 21/01/2021 |