Healthcare Provider Details

I. General information

NPI: 1063803039
Provider Name (Legal Business Name): ENJOH NJONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21399 TULANE AVE
FARMINGTON HILLS MI
48336-5675
US

IV. Provider business mailing address

21399 TULANE AVE
FARMINGTON HILLS MI
48336-5675
US

V. Phone/Fax

Practice location:
  • Phone: 313-310-6092
  • Fax:
Mailing address:
  • Phone: 313-310-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703112486
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: