MEDICARE: PATRICIA NWADINMA EZIRIKE PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209029493	IL
2	363LF0000X	Family Nurse Practitioner	209029493	IL

General Provider Information

NPI Number	:	1033965207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA NWADINMA EZIRIKE PMHNP

Provider Business Mailing Address
First Line	:	2207 W LUNT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4817
Country	:	US
Telephone Number	:	773-297-7911
Fax Number	:

Provider Business Practice Location Address
First Line	:	2207 W LUNT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4817
Country	:	US
Telephone Number	:	773-297-7911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2024
Last Update Date	:	02/27/2025

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