Provider Demographics
NPI:1033844998
Name:EHIZUELEN, OMOYEME ALICESON (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:OMOYEME
Middle Name:ALICESON
Last Name:EHIZUELEN
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1700 NORTHSIDE DRIVE NW
Mailing Address - Street 2:SUITE A7 PMB 2078
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318
Mailing Address - Country:US
Mailing Address - Phone:404-566-8045
Mailing Address - Fax:404-999-6787
Practice Address - Street 1:10 PERIMETER PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341
Practice Address - Country:US
Practice Address - Phone:404-566-8045
Practice Address - Fax:404-999-6787
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2024-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA313937363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health