Provider Demographics
NPI:1144025719
Name:ANUGWOM, OBINNA F
Entity type:Individual
Prefix:
First Name:OBINNA
Middle Name:F
Last Name:ANUGWOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 S 109TH DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-8357
Mailing Address - Country:US
Mailing Address - Phone:480-526-3580
Mailing Address - Fax:
Practice Address - Street 1:2110 S 109TH DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-8357
Practice Address - Country:US
Practice Address - Phone:480-526-3580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ262250164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse