Provider Demographics
NPI:1174096572
Name:EMENIKE, EBELE CORDELIA (RN)
Entity type:Individual
Prefix:
First Name:EBELE
Middle Name:CORDELIA
Last Name:EMENIKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SOMERSET VALE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-6054
Mailing Address - Country:US
Mailing Address - Phone:678-656-6763
Mailing Address - Fax:
Practice Address - Street 1:620 SOMERSET VALE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-6054
Practice Address - Country:US
Practice Address - Phone:678-656-6763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN246905163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty