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NPI Code Detail

MEDICARE: MRS. ETHEL IHEDINANWA EMENOGU NP

MEDICARE:  MRS. ETHEL IHEDINANWA EMENOGU  NP
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
1363LF0000XFamily Nurse Practitioner19826CA

General Provider Information

NPI Number : 1457636524
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ETHEL IHEDINANWA EMENOGU NP
Provider Business Mailing Address
First Line : 2916 W 134TH PL
Second Line :
City : GARDENA
State : CA
Zip : 90249-1523
Country : US
Telephone Number : 213-427-4000
Fax Number : 213-427-4008
Provider Business Practice Location Address
First Line : 3727 W 6TH ST STE 200
Second Line :
City : LOS ANGELES
State : CA
Zip : 90020-5108
Country : US
Telephone Number : 213-427-4000
Fax Number : 213-427-4008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2011
Last Update Date : 10/20/2011

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