Provider Demographics
NPI:1235370362
Name:ENE, JUSTINA OBIAMAKA (MT (AMT))
Entity Type:Individual
Prefix:MRS
First Name:JUSTINA
Middle Name:OBIAMAKA
Last Name:ENE
Suffix:
Gender:F
Credentials:MT (AMT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2904 CREEKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5047
Mailing Address - Country:US
Mailing Address - Phone:972-446-1186
Mailing Address - Fax:972-636-8165
Practice Address - Street 1:2904 CREEKSIDE CT
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5047
Practice Address - Country:US
Practice Address - Phone:972-446-1186
Practice Address - Fax:972-636-8165
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178486246Q00000X, 246QB0000X, 246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology
No246QB0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyBlood Banking