Provider Demographics
NPI:1497283097
Name:EZE, CHIDINMA (PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:CHIDINMA
Middle Name:
Last Name:EZE
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-C
Other - Prefix:DR
Other - First Name:CHIDINMA
Other - Middle Name:
Other - Last Name:EZE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C, PMHNP-BC
Mailing Address - Street 1:9912 FARM POND RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-6000
Mailing Address - Country:US
Mailing Address - Phone:301-254-6807
Mailing Address - Fax:
Practice Address - Street 1:1221 TAYLOR ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5617
Practice Address - Country:US
Practice Address - Phone:202-464-9200
Practice Address - Fax:202-291-2160
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185830363LF0000X, 363LP0808X
DCRN1015900363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD628655Medicaid