Provider Demographics
NPI:1003502238
Name:EZENNAKA, CHIDINMA (DNP-FNP)
Entity Type:Individual
Prefix:DR
First Name:CHIDINMA
Middle Name:
Last Name:EZENNAKA
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6649 THISTLE DOWN DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-6687
Mailing Address - Country:US
Mailing Address - Phone:980-226-8360
Mailing Address - Fax:
Practice Address - Street 1:6649 THISTLE DOWN DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-6687
Practice Address - Country:US
Practice Address - Phone:980-226-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily