Provider Demographics
NPI:1912567504
Name:EMENYI, NJIDEKA NKEMJIKA
Entity Type:Individual
Prefix:
First Name:NJIDEKA
Middle Name:NKEMJIKA
Last Name:EMENYI
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 1:735 BLUE MOON LN
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7059
Mailing Address - Country:US
Mailing Address - Phone:443-821-0717
Mailing Address - Fax:443-821-0720
Practice Address - Street 1:309 E PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6792
Practice Address - Country:US
Practice Address - Phone:443-559-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210157363LF0000X, 363LP0808X
TXAP141853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily