Provider Demographics
NPI:1508366642
Name:EMERUEM, NWAMAKA LARVINE
Entity Type:Individual
Prefix:
First Name:NWAMAKA
Middle Name:LARVINE
Last Name:EMERUEM
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 1:402 W WHEATLAND RD STE 140
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4628
Mailing Address - Country:US
Mailing Address - Phone:972-503-4109
Mailing Address - Fax:972-449-0500
Practice Address - Street 1:2512 E EVERGREEN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4323
Practice Address - Country:US
Practice Address - Phone:972-503-4109
Practice Address - Fax:972-449-0500
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136592363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care