Provider Demographics
NPI:1609627983
Name:TETENTA-NJEMANZE, IBIWARI ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:IBIWARI
Middle Name:ELIZABETH
Last Name:TETENTA-NJEMANZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25814 BECK RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2216
Mailing Address - Country:US
Mailing Address - Phone:405-716-0010
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 530
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program