Provider Demographics
NPI:1043785900
Name:EKWUEME, PHILOMENA O (LPN)
Entity Type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:O
Last Name:EKWUEME
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4509 N 76TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-5343
Mailing Address - Country:US
Mailing Address - Phone:925-726-1918
Mailing Address - Fax:
Practice Address - Street 1:4509 N 76TH ST APT 1
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-5343
Practice Address - Country:US
Practice Address - Phone:925-726-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI322757-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse