MEDICARE: CHIZOBA ADAMMA EZENYI

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	17727-33	WI

General Provider Information

NPI Number	:	1699639385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIZOBA ADAMMA EZENYI

Provider Business Mailing Address
First Line	:	3915 W MARIANA CT
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-5190
Country	:	US
Telephone Number	:	240-606-9376
Fax Number	:

Provider Business Practice Location Address
First Line	:	3915 W MARIANA CT
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-5190
Country	:	US
Telephone Number	:	240-606-9376
Fax Number	:

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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