Provider Demographics
NPI:1073091260
Name:ENO, IJEJE ETENG (APRN)
Entity Type:Individual
Prefix:
First Name:IJEJE
Middle Name:ETENG
Last Name:ENO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 HARVEST HILL RD STE 182B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1607
Mailing Address - Country:US
Mailing Address - Phone:214-348-7611
Mailing Address - Fax:214-348-0129
Practice Address - Street 1:5440 HARVEST HILL RD STE 182
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1605
Practice Address - Country:US
Practice Address - Phone:972-484-0040
Practice Address - Fax:972-484-0070
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily