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1265995260 NPI number — WINIFRED C EZENWA NURSE PRACTITIONER

NPI Number: 1265995260
Health Care Provider/Practitioner: WINIFRED C EZENWA NURSE PRACTITIONER

Information about “1265995260” NPI (WINIFRED C EZENWA NURSE PRACTITIONER) exists in 1265995260 in HTML format HTML  |  1265995260 in plain Text format TXT  |  1265995260 in PDF (Portable Document Format) PDF  |  1265995260 in an XML format XML  formats.

NPI Number : 1265995260 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265995260",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EZENWA",
    "FirstName": "WINIFRED",
    "MiddleName": "C",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NURSE PRACTITIONER",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16133 S VERMONT AVE UNIT 17",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GARDENA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90247-4986",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-953-7004",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11938 PARAMOUNT BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DOWNEY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90242-2306",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "562-923-6060",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/08/2019",
    "LastUpdateDate": "04/08/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "F11180567",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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