Provider Demographics
NPI:1558847970
Name:IREBUISI, EMMANUELA ONYINYECHI (NP)
Entity Type:Individual
Prefix:
First Name:EMMANUELA
Middle Name:ONYINYECHI
Last Name:IREBUISI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EMMANUELA
Other - Middle Name:ONYINYECHI
Other - Last Name:OGBUGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1514 VERNON RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4131
Mailing Address - Country:US
Mailing Address - Phone:706-812-2369
Mailing Address - Fax:706-845-3194
Practice Address - Street 1:1514 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4131
Practice Address - Country:US
Practice Address - Phone:706-812-2369
Practice Address - Fax:706-845-3194
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN246020163W00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse