Provider Demographics
NPI:1609414218
Name:NZOMA, RUBY (FNP)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:
Last Name:NZOMA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RUBY
Other - Middle Name:NDEVE
Other - Last Name:NZOMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:25774 DUNBAR ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5859
Mailing Address - Country:US
Mailing Address - Phone:313-204-0925
Mailing Address - Fax:
Practice Address - Street 1:25774 DUNBAR ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5859
Practice Address - Country:US
Practice Address - Phone:313-204-0925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily