Provider Demographics
NPI:1265155147
Name:MBI, IRENE ENOW (NP)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:ENOW
Last Name:MBI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 HAMMOND DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5848
Mailing Address - Country:US
Mailing Address - Phone:256-417-3070
Mailing Address - Fax:
Practice Address - Street 1:626 HAMMOND DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5848
Practice Address - Country:US
Practice Address - Phone:256-417-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1093386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily