Provider Demographics
NPI:1316107584
Name:EJIMADU, ADAKU CHINWENDU (FNP-BC)
Entity type:Individual
Prefix:
First Name:ADAKU
Middle Name:CHINWENDU
Last Name:EJIMADU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 FM 1488 RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4928
Mailing Address - Country:US
Mailing Address - Phone:778-682-5288
Mailing Address - Fax:
Practice Address - Street 1:4714 FM 1488 RD STE 132
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-4930
Practice Address - Country:US
Practice Address - Phone:877-868-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily