Provider Demographics
NPI:1275988115
Name:EZEANOLUE, ADAOBI (APRN)
Entity Type:Individual
Prefix:
First Name:ADAOBI
Middle Name:
Last Name:EZEANOLUE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 BEARDEN DR
Mailing Address - Street 2:STE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4189
Mailing Address - Country:US
Mailing Address - Phone:702-310-9110
Mailing Address - Fax:702-310-9114
Practice Address - Street 1:1701 BEARDEN DR
Practice Address - Street 2:STE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4189
Practice Address - Country:US
Practice Address - Phone:702-310-9110
Practice Address - Fax:702-310-9114
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002189363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health