Provider Demographics
NPI:1679190706
Name:EZIEFULA, CHUKS G
Entity Type:Individual
Prefix:
First Name:CHUKS
Middle Name:G
Last Name:EZIEFULA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4931 N CAPITOL ST NE APT 31
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6752
Mailing Address - Country:US
Mailing Address - Phone:240-476-5218
Mailing Address - Fax:
Practice Address - Street 1:4931 N CAPITOL ST NE APT 31
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6752
Practice Address - Country:US
Practice Address - Phone:240-473-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1040687163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty