Provider Demographics
NPI:1750821104
Name:EMEJULU, IZUCHUKWU MCIVER (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:IZUCHUKWU
Middle Name:MCIVER
Last Name:EMEJULU
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6028 SURETY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2018
Mailing Address - Country:US
Mailing Address - Phone:915-544-3500
Mailing Address - Fax:915-532-4433
Practice Address - Street 1:6028 SURETY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2018
Practice Address - Country:US
Practice Address - Phone:915-544-3500
Practice Address - Fax:915-532-4433
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133488363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health