Healthcare Provider Details

I. General information

NPI: 1861937773
Provider Name (Legal Business Name): EZECHUKWU PRINCE IBEKWE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2016
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 WATTS LN
RICHMOND VA
23223-1951
US

IV. Provider business mailing address

2224 WATTS LN
RICHMOND VA
23223-1951
US

V. Phone/Fax

Practice location:
  • Phone: 804-247-3997
  • Fax:
Mailing address:
  • Phone: 804-247-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001238827
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001238827
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0001238827
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0001238827
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: