Provider Demographics
NPI:1275127938
Name:EZEDIKE, URSULA NKEIRU
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:NKEIRU
Last Name:EZEDIKE
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 1:309 JOPPA CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3742
Mailing Address - Country:US
Mailing Address - Phone:410-916-4826
Mailing Address - Fax:
Practice Address - Street 1:309 JOPPA CROSSING WAY
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3742
Practice Address - Country:US
Practice Address - Phone:410-916-4826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185126363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health