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General NPI Number Information
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NPI Number | 1790274074
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Entity Type | Individual
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Provider Name | FERDINAND EKWUTOSI ENUDU NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 100 LAKE TRAVERSE DR
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City | SISSETON
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State | SD
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Zip | 57262-7046
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Country | US
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Telephone | 605-698-7606
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Fax | 651-431-7462
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Provider Business Mailing Address
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Address Line | 512 OLD AGENCY DR UNIT 138
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City | SISSETON
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State | SD
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Zip | 57262-7227
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Country | US
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Telephone | 713-478-5660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 137180
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License Number State | TX
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