Provider Demographics
NPI:1306697487
Name:ABLE INTEGRATIVE PRACTICE LLC
Entity type:Organization
Organization Name:ABLE INTEGRATIVE PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NNEKA
Authorized Official - Middle Name:EZINWANNE
Authorized Official - Last Name:IKEDINMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-629-0598
Mailing Address - Street 1:17822 PLANTERS PATH LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5183
Mailing Address - Country:US
Mailing Address - Phone:610-401-3870
Mailing Address - Fax:
Practice Address - Street 1:17822 PLANTERS PATH LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-5183
Practice Address - Country:US
Practice Address - Phone:610-401-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty