Provider Demographics
NPI:1043912843
Name:EKANEM, UNYIME (FNP)
Entity Type:Individual
Prefix:
First Name:UNYIME
Middle Name:
Last Name:EKANEM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9915 HUNTERS RUN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9262
Mailing Address - Country:US
Mailing Address - Phone:618-203-2217
Mailing Address - Fax:
Practice Address - Street 1:9915 HUNTERS RUN
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9262
Practice Address - Country:US
Practice Address - Phone:618-203-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty