Provider Demographics
NPI:1588164214
Name:AKENJI, ADRIENNE NGELO
Entity type:Individual
Prefix:MISS
First Name:ADRIENNE
Middle Name:NGELO
Last Name:AKENJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:TX
Practice Address - Zip Code:76055-2506
Practice Address - Country:US
Practice Address - Phone:254-384-4862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341103164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341103OtherNURSE