MEDICARE: EZINNE NDUKWE

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	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1336530856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EZINNE NDUKWE

Provider Business Mailing Address
First Line	:	1279 E DUBLIN GRANVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1279 E DUBLIN GRANVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3300
Country	:	US
Telephone Number	:	513-903-7019
Fax Number	:

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

Provider Enumeration Date	:	02/06/2015
Last Update Date	:	02/06/2015

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Directions to “ EZINNE NDUKWE ” Practice Location

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