Provider Demographics
NPI:1477024057
Name:ABANAKA, EMMANUEL C
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:C
Last Name:ABANAKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CREEKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6552
Mailing Address - Country:US
Mailing Address - Phone:469-441-9581
Mailing Address - Fax:
Practice Address - Street 1:421 CREEKWOOD LN
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6552
Practice Address - Country:US
Practice Address - Phone:469-441-9581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226091164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse