Provider Demographics
NPI:1902252653
Name:ANUONYE, MARTIN (LPN)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:ANUONYE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 CRISP WOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0685
Mailing Address - Country:US
Mailing Address - Phone:980-833-0699
Mailing Address - Fax:
Practice Address - Street 1:3112 CRISP WOOD LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0685
Practice Address - Country:US
Practice Address - Phone:980-833-0699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15520343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)