Individual
ETOHN NIMENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3034 MEADOW CHURCH RD, SUWANEE, GA 30024-3678
(678) 478-5842
Mailing address
3034 MEADOW CHURCH RD, SUWANEE, GA 30024-3678
(678) 478-5842
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
E1946723
TX
164W00000X
Licensed Practical Nurse
323645
TX
164W00000X
Licensed Practical Nurse
Primary
LPN091164
GA
Other
Enumeration date
07/13/2015
Last updated
07/13/2015
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