Provider Demographics
NPI:1366258493
Name:ANIKAMADU, FAUSTINA NKOLIKA (FNP-BC)
Entity type:Individual
Prefix:
First Name:FAUSTINA
Middle Name:NKOLIKA
Last Name:ANIKAMADU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 WRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6234
Mailing Address - Country:US
Mailing Address - Phone:847-971-9631
Mailing Address - Fax:
Practice Address - Street 1:420 WRIGHT DR
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-6234
Practice Address - Country:US
Practice Address - Phone:847-971-9631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily