Provider Demographics
NPI:1811640634
Name:EMENIKE, EDWIN NNAMDI
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:NNAMDI
Last Name:EMENIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12720 TANTARA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-6445
Mailing Address - Country:US
Mailing Address - Phone:737-333-1630
Mailing Address - Fax:
Practice Address - Street 1:12720 TANTARA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-6445
Practice Address - Country:US
Practice Address - Phone:737-333-1630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)