MEDICARE: RITA EZEH

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	4704325978	MI

General Provider Information

NPI Number	:	1417728288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA EZEH

Provider Business Mailing Address
First Line	:	3501 INVERNESS DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4757
Country	:	US
Telephone Number	:	860-910-7772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 E HILL RD STE F
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-5425
Country	:	US
Telephone Number	:	248-904-7093
Fax Number	:	810-498-4989

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

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	03/16/2026

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Directions to “ RITA EZEH ” Practice Location

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