| Amanji Llc | |
|
9908 Lamberton Ter Fort Worth TX 76244-8514 | |
| (817) 980-5659 | |
| (917) 722-1713 |
| Full Name | Amanji Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 9908 Lamberton Ter, Fort Worth, Texas |
| Authorized Official Name and Position | Lawretta Ezukanma (PROVIDER & OWNER) |
| Authorized Official Contact | 8179805659 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amanji Llc 9908 Lamberton Ter Fort Worth TX 76244-8514 Ph: (817) 980-5659 | Amanji Llc 9908 Lamberton Ter Fort Worth TX 76244-8514 Ph: (817) 980-5659 |
| NPI Number | 1538937818 |
|---|---|
| Provider Enumeration Date | 12/15/2023 |
| Last Update Date | 12/15/2023 |
| Certification Date | 12/15/2023 |
| Medicare PECOS PAC ID | 1850736893 |
|---|---|
| Medicare Enrollment ID | O20240229000375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538937818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Lawretta Njideka Ezukanma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841526142 PECOS PAC ID: 8628233525 Enrollment ID: I20240229000554 |
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