Healthcare Provider Details

I. General information

NPI: 1548569833
Provider Name (Legal Business Name): IFEYINWA ONYEMAECHI MAZELI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IFEYINWA ANYALEWECHI

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 N BREIEL BLVD
MIDDLETOWN OH
45042-3807
US

IV. Provider business mailing address

PO BOX 706384
CINCINNATI OH
45270-6384
US

V. Phone/Fax

Practice location:
  • Phone: 513-318-1188
  • Fax: 513-318-1189
Mailing address:
  • Phone: 513-318-1188
  • Fax: 513-318-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN254448
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0030474
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: