=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912684333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIND YOUR THOUGHTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2023
-----------------------------------------------------
Last Update Date | 06/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 MENZEL AVE
-----------------------------------------------------
City | MAPLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07040-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-305-0033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 MENZEL AVE
-----------------------------------------------------
City | MAPLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07040-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-305-0033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER NP
-----------------------------------------------------
Name | NNEKA EMENAKA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-305-0033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------