Provider Demographics
NPI:1194211029
Name:NKAI NJUIKEM, MARY NKEMEBI III
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NKEMEBI
Last Name:NKAI NJUIKEM
Suffix:III
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 FIREBUSH DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-8949
Mailing Address - Country:US
Mailing Address - Phone:256-694-6051
Mailing Address - Fax:
Practice Address - Street 1:1408 FIREBUSH DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-8949
Practice Address - Country:US
Practice Address - Phone:256-694-6051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX942727163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse