Provider Demographics
NPI:1649595851
Name:ERUCHALU, JOY NGOZI (RN)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:NGOZI
Last Name:ERUCHALU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:11121 W HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-5037
Mailing Address - Country:US
Mailing Address - Phone:414-153-6344
Mailing Address - Fax:
Practice Address - Street 1:11121 W HERITAGE DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-5037
Practice Address - Country:US
Practice Address - Phone:414-153-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132316-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse