Provider Demographics
NPI:1639487648
Name:EJIKEME, CHRISTIANA CHIDI
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIANA
Middle Name:CHIDI
Last Name:EJIKEME
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 1:5350 GREAT OAK WAY APT D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4509
Mailing Address - Country:US
Mailing Address - Phone:614-577-0193
Mailing Address - Fax:
Practice Address - Street 1:5350 GREAT OAK WAY APT D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4509
Practice Address - Country:US
Practice Address - Phone:614-577-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH137434164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse