Basic Information
| Provider Information | |||||||||
| NPI: | 1730766494 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANIAGBOSO | ||||||||
| FirstName: | CHIOMA | ||||||||
| MiddleName: | VERONICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 SARAH ST | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023681906 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 632 BLUE HILL AVE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021213213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178253400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2021 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 2329332 | MA | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.