Healthcare Provider Details

I. General information

NPI: 1699445544
Provider Name (Legal Business Name): MOSES EKEZE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E MAIN ST
COLUMBUS OH
43213-3593
US

IV. Provider business mailing address

140 E TOWN ST STE 1450
COLUMBUS OH
43215-6601
US

V. Phone/Fax

Practice location:
  • Phone: 614-639-6590
  • Fax:
Mailing address:
  • Phone: 614-639-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0034859
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number417632
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: