Provider Demographics
NPI:1306013859
Name:EZEDIARO-EFOBI, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:EZEDIARO-EFOBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:EZEDIARO-EFOBI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:30 ALBERMARLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2001
Mailing Address - Country:US
Mailing Address - Phone:914-576-1415
Mailing Address - Fax:
Practice Address - Street 1:1780 STILLWELL AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-6409
Practice Address - Country:US
Practice Address - Phone:718-652-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY548739163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice