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General NPI Number Information
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NPI Number | 1578377404
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Entity Type | Individual
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Provider Name | EDITH IFEYINWA EZEKWE RDN, ASCP,
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Gender | Female
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 703 FARMER ST
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City | PORT GIBSON
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State | MS
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Zip | 39150-2319
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Country | US
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Telephone | 601-437-5668
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Fax |
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Provider Business Mailing Address
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Address Line | 123 BROOKWOOD DR
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City | VICKSBURG
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State | MS
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Zip | 39183-1622
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Country | US
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Telephone | 601-415-1249
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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 | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number | 914536
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License Number State | MS
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