Provider Demographics
NPI:1093585192
Name:ELEAZU, CHARITY IFEOMA
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:IFEOMA
Last Name:ELEAZU
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 1:18 CHERRY HILL AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1916
Mailing Address - Country:US
Mailing Address - Phone:978-223-2632
Mailing Address - Fax:
Practice Address - Street 1:18 CHERRY HILL AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-1916
Practice Address - Country:US
Practice Address - Phone:978-332-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2341951163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)