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General NPI Number Information
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NPI Number | 1306697487
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Entity Type | Organization
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Legal Business Name | ABLE INTEGRATIVE PRACTICE LLC
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 17822 PLANTERS PATH LN
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City | RICHMOND
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State | TX
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Zip | 77407-5183
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Country | US
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Telephone | 610-401-3870
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Fax |
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Provider Business Mailing Address
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Address Line | 17822 PLANTERS PATH LN
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City | RICHMOND
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State | TX
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Zip | 77407-5183
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Country | US
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Telephone | 610-401-3870
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | NNEKA EZINWANNE IKEDINMA
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Credential |
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Telephone | 507-629-0598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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