Provider Demographics
NPI:1619170297
Name:NNONYITUM S EJESIEME
Entity Type:Organization
Organization Name:NNONYITUM S EJESIEME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NNONYITUM
Authorized Official - Middle Name:S
Authorized Official - Last Name:EJESIEME
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-365-7147
Mailing Address - Street 1:2504 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-6733
Mailing Address - Country:US
Mailing Address - Phone:972-365-7147
Mailing Address - Fax:972-463-1671
Practice Address - Street 1:2504 LARKSPUR LN
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-6733
Practice Address - Country:US
Practice Address - Phone:972-365-7147
Practice Address - Fax:972-463-1671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-09
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011635251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health