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General NPI Number Information
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NPI Number | 1679190706
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Entity Type | Individual
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Provider Name | CHUKS G EZIEFULA
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Gender | Male
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 4931 N CAPITOL ST NE APT 31
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City | WASHINGTON
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State | DC
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Zip | 20011-6752
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Country | US
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Telephone | 240-473-5218
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Fax |
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Provider Business Mailing Address
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Address Line | 4931 N CAPITOL ST NE APT 31
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City | WASHINGTON
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State | DC
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Zip | 20011-6752
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Country | US
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Telephone | 240-476-5218
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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 | R220917
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | RN1040687
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License Number State | DC
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