Provider Demographics
NPI:1326213299
Name:ASI, EZUMA E (RN)
Entity Type:Individual
Prefix:
First Name:EZUMA
Middle Name:E
Last Name:ASI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 MAITLAND DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1239
Mailing Address - Country:US
Mailing Address - Phone:919-250-1989
Mailing Address - Fax:
Practice Address - Street 1:3537 MAITLAND DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1239
Practice Address - Country:US
Practice Address - Phone:919-250-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health