Healthcare Provider Details

I. General information

NPI: 1750821104
Provider Name (Legal Business Name): IZUCHUKWU MCIVER EMEJULU PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 04/14/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 ELBOWOODS LOOP
NEW TOWN ND
58763
US

IV. Provider business mailing address

1235 LAKE POINTE PKWY STE 104
SUGAR LAND TX
77478-4077
US

V. Phone/Fax

Practice location:
  • Phone: 701-627-4750
  • Fax:
Mailing address:
  • Phone: 844-824-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number803843
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP133488
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: