Individual
ISIMENMEN ETAKIBUEBU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, M.ED., APRN
Contact information
Practice address
1631 E 2ND ST STE D, AUSTIN, TX 78702-4491
(512) 804-3663
(512) 476-1469
Mailing address
1631 E 2ND ST STE D, AUSTIN, TX 78702-4491
(512) 804-3663
(512) 476-1469
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
988738
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1157891
TX
Other
Enumeration date
04/08/2020
Last updated
01/19/2025
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