Provider Demographics
NPI:1558996520
Name:EJIKEMEH, MERCY OLUNMA (CRNP, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MERCY
Middle Name:OLUNMA
Last Name:EJIKEMEH
Suffix:
Gender:F
Credentials:CRNP, NP-C
Other - Prefix:MISS
Other - First Name:MERCY
Other - Middle Name:
Other - Last Name:EJIKEMEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP, NP-C
Mailing Address - Street 1:4625 RIDDLE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5702
Mailing Address - Country:US
Mailing Address - Phone:443-858-6744
Mailing Address - Fax:
Practice Address - Street 1:4625 RIDDLE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5702
Practice Address - Country:US
Practice Address - Phone:443-858-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160203363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner