Provider Demographics
NPI:1396073599
Name:ENOBAKHARE, EFEHI H
Entity type:Individual
Prefix:
First Name:EFEHI
Middle Name:H
Last Name:ENOBAKHARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EFEHI
Other - Middle Name:H
Other - Last Name:IGBINOVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1013 CHAMPLAIN DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1245
Mailing Address - Country:US
Mailing Address - Phone:817-422-6925
Mailing Address - Fax:
Practice Address - Street 1:1805 E RUBEN M TORRES BLVD
Practice Address - Street 2:SUITE A-3
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:956-561-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
486010YLPSOtherWELLMED MEDICAL GROUP PA
486010YMVUOtherWELLMED NETWORKS INC