Provider Demographics
NPI:1962239228
Name:EJELLE-NDILLE, IRENE NANGE (FNP)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:NANGE
Last Name:EJELLE-NDILLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 LAUREL KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-9212
Mailing Address - Country:US
Mailing Address - Phone:404-246-2396
Mailing Address - Fax:
Practice Address - Street 1:3452 LAUREL KNOLL CT
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-9212
Practice Address - Country:US
Practice Address - Phone:404-246-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160853363LF0000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care