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General NPI Number Information
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NPI Number | 1619170297
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Entity Type | Organization
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Legal Business Name | NNONYITUM S EJESIEME
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Dates
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Enumeration Date | 06/09/2007
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Last Update Date | 06/01/2008
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Provider Practice Location Address
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Address Line | 2504 LARKSPUR LN
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City | ROWLETT
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State | TX
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Zip | 75089-6733
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Country | US
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Telephone | 972-365-7147
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Fax | 972-463-1671
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Provider Business Mailing Address
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Address Line | 2504 LARKSPUR LN
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City | ROWLETT
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State | TX
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Zip | 75089-6733
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Country | US
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Telephone | 972-365-7147
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Fax | 972-463-1671
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Authorized Official
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Title or Position | OWNER ADMINISTRATOR
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Name | NNONYITUM S EJESIEME
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Credential | RN
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Telephone | 972-365-7147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 011635
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License Number State | TX
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