Basic Information
| Provider Information | |||||||||
| NPI: | 1124467220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANOKAM | ||||||||
| FirstName: | CHIOMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14912 LONDON LN | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207152546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028328340 | ||||||||
| FaxNumber: | 2022914009 | ||||||||
| Practice Location | |||||||||
| Address1: | 439 ONEIDA PL NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200112150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022917226 | ||||||||
| FaxNumber: | 2022914009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2013 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WH0200X | RN1055048 | DC | Y | Nursing Service Providers | Registered Nurse | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 036061400 | 05 | DC | MEDICAID |