Provider Demographics
NPI:1326573494
Name:NWAOHA-EZEKWO, THERESA A
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:A
Last Name:NWAOHA-EZEKWO
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 1:10324 GRACIOSA WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3464
Mailing Address - Country:US
Mailing Address - Phone:916-529-3398
Mailing Address - Fax:
Practice Address - Street 1:10324 GRACIOSA WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3464
Practice Address - Country:US
Practice Address - Phone:916-529-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95006334363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care