Provider Demographics
NPI:1427311141
Name:EGBE, EMMANUEL A
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:A
Last Name:EGBE
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 1:8258A FOUR WORLDS DR APT 12
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5696
Mailing Address - Country:US
Mailing Address - Phone:815-823-2082
Mailing Address - Fax:
Practice Address - Street 1:8258A FOUR WORLDS DR APT 12
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-5696
Practice Address - Country:US
Practice Address - Phone:815-823-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133211164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse