MEDICARE: IJEJE ETENG ENO APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP138145	TX

General Provider Information

NPI Number	:	1073091260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IJEJE ETENG ENO APRN

Provider Business Mailing Address
First Line	:	5440 HARVEST HILL RD STE 182B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1607
Country	:	US
Telephone Number	:	214-348-7611
Fax Number	:	214-348-0129

Provider Business Practice Location Address
First Line	:	5440 HARVEST HILL RD STE 182
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1605
Country	:	US
Telephone Number	:	972-484-0040
Fax Number	:	972-484-0070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2018
Last Update Date	:	07/31/2018

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Directions to “ IJEJE ETENG ENO APRN” Practice Location

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