Provider Demographics
NPI:1528703261
Name:MBI, EMMANUEL E
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:E
Last Name:MBI
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 1:626 HAMMOND DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5848
Mailing Address - Country:US
Mailing Address - Phone:256-479-4472
Mailing Address - Fax:817-225-2396
Practice Address - Street 1:808 SW GREEN OAKS BULVD
Practice Address - Street 2:SUITE 402
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017
Practice Address - Country:US
Practice Address - Phone:256-479-4472
Practice Address - Fax:817-225-2396
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ279173363LP0808X
TX866937363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty