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General NPI Number Information
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NPI Number | 1851785828
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Entity Type | Individual
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Provider Name | CHINOMSO D EZENWATA NP-C
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Gender | Male
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 3110 S DURANGO DR STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89117
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Country | US
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Telephone | 702-415-9760
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Fax | 702-478-6211
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Provider Business Mailing Address
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Address Line | PO BOX 30771
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City | LAS VEGAS
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State | NV
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Zip | 89173-0771
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Country | US
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Telephone | 702-159-7604
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Fax | 702-478-6211
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN001829
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License Number State | NV
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