Provider Demographics
NPI:1487214938
Name:JUMBO, ELIZABETH IPIRIYE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:IPIRIYE
Last Name:JUMBO
Suffix:
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 1:10528 PARK CITY TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-6598
Mailing Address - Country:US
Mailing Address - Phone:682-498-7145
Mailing Address - Fax:
Practice Address - Street 1:10528 PARK CITY TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-6598
Practice Address - Country:US
Practice Address - Phone:682-498-7145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program