Provider Demographics
NPI:1437382652
Name:EZEIBE, JOANN NNEKA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:NNEKA
Last Name:EZEIBE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MRS
Other - First Name:JOANN
Other - Middle Name:NNEKA
Other - Last Name:EZEIBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, BSN, PMHNP-DNP
Mailing Address - Street 1:18202 COLTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1736
Mailing Address - Country:US
Mailing Address - Phone:310-658-7879
Mailing Address - Fax:
Practice Address - Street 1:18202 COLTMAN AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1736
Practice Address - Country:US
Practice Address - Phone:310-658-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95176020163WP0809X
CAVN226937164X00000X
CA95029134363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No164X00000XNursing Service ProvidersLicensed Vocational Nurse