Provider Demographics
NPI:1093410581
Name:EZE, NGOZI REGINA
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:REGINA
Last Name:EZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 GOLDEN BELT PKWY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8321
Mailing Address - Country:US
Mailing Address - Phone:919-423-4871
Mailing Address - Fax:
Practice Address - Street 1:4528 HILLSBOROUGH RD STE 295
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1214
Practice Address - Country:US
Practice Address - Phone:919-423-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPENDING364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family