MEDICARE: ERINMA ONYEKACHI EZEUGWA

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	363LF0000X	Family Nurse Practitioner	4704299407	MI

General Provider Information

NPI Number	:	1245775683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERINMA ONYEKACHI EZEUGWA

Provider Business Mailing Address
First Line	:	46156 WOODWARD AVE
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48342-5033
Country	:	US
Telephone Number	:	248-897-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	46156 WOODWARD AVE
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48342-5033
Country	:	US
Telephone Number	:	248-322-6747
Fax Number	:

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

Provider Enumeration Date	:	12/20/2016
Last Update Date	:	11/05/2020

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Directions to “ ERINMA ONYEKACHI EZEUGWA ” Practice Location

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