Healthcare Provider Details

I. General information

NPI: 1720717820
Provider Name (Legal Business Name): MS. AMARACHI EZI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

IV. Provider business mailing address

13312 OROURKE DR
PFLUGERVILLE TX
78660-5683
US

V. Phone/Fax

Practice location:
  • Phone: 512-447-4141
  • Fax:
Mailing address:
  • Phone: 737-230-1959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number814457
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: