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General NPI Number Information
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NPI Number | 1023906997
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Entity Type | Individual
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Provider Name | GRACE CHIDINMA EZENWAKA PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 250 S TOOLE AVE STE B
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City | TUCSON
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State | AZ
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Zip | 85701-1814
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Country | US
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Telephone | 520-617-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 6311 W MAGDALENA LN
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City | LAVEEN
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State | AZ
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Zip | 85339-5483
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Country | US
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Telephone | 480-749-9098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 262215
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License Number State | AZ
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