MEDICARE: LYNDA EZEZE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP129111	TX

General Provider Information

NPI Number	:	1447623293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA EZEZE NP

Provider Business Mailing Address
First Line	:	7823 SUN RISE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-5646
Country	:	US
Telephone Number	:	216-496-0549
Fax Number	:

Provider Business Practice Location Address
First Line	:	7823 SUN RISE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-5646
Country	:	US
Telephone Number	:	216-496-0549
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	09/16/2016

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