Provider Demographics
NPI:1891440210
Name:IJEH, NKENNA ROSELINE
Entity Type:Individual
Prefix:
First Name:NKENNA
Middle Name:ROSELINE
Last Name:IJEH
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 1:5 HARBOR FRONT CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206-1951
Mailing Address - Country:US
Mailing Address - Phone:908-422-8328
Mailing Address - Fax:
Practice Address - Street 1:5 HARBOR FRONT CT
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206-1951
Practice Address - Country:US
Practice Address - Phone:908-422-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01227600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health