Provider Demographics
NPI:1043700644
Name:ANYANWU, JORDAN ASHLEY BROWNING (DO)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ASHLEY BROWNING
Last Name:ANYANWU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ASHLEY
Other - Last Name:BROWNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4881 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WRIGHT PAT
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:WRIGHT PAT
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:228-376-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.014732208600000X
OH0152160146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate