Healthcare Provider Details

I. General information

NPI: 1639325806
Provider Name (Legal Business Name): JEANNETTE NJI NVUH MBAIMOUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 WILDWOOD WAY
KELLER TX
76262-8811
US

IV. Provider business mailing address

1202 N MUSKOGEE PL
CLAREMORE OK
74017-3058
US

V. Phone/Fax

Practice location:
  • Phone: 248-872-4225
  • Fax:
Mailing address:
  • Phone: 918-341-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ4653
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberQ4653
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: