Healthcare Provider Details

I. General information

NPI: 1740805613
Provider Name (Legal Business Name): NWAMAKA F EZIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 MARION BARRY AVE SE
WASHINGTON DC
20020-5615
US

IV. Provider business mailing address

3611 BRANCH AVE
TEMPLE HILLS MD
20748-1242
US

V. Phone/Fax

Practice location:
  • Phone: 202-796-5000
  • Fax:
Mailing address:
  • Phone: 303-909-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR182741
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1014552
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: