Healthcare Provider Details

I. General information

NPI: 1780466060
Provider Name (Legal Business Name): EMMANUEL ENOABANE ENOW NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 BRADENTON AVE STE A
DUBLIN OH
43017-3524
US

IV. Provider business mailing address

483 PRUDEN DR
PICKERINGTON OH
43147-2239
US

V. Phone/Fax

Practice location:
  • Phone: 614-389-5452
  • Fax: 614-389-5399
Mailing address:
  • Phone: 614-743-4916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0035170
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.431803
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: