Provider Demographics
NPI:1679285472
Name:EZIGBO, MARTINA ONAH (APRN)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:ONAH
Last Name:EZIGBO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:EMBAR
Other - Last Name:ONAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:961 GRASSWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6131
Mailing Address - Country:US
Mailing Address - Phone:469-774-9964
Mailing Address - Fax:
Practice Address - Street 1:3425 HIGHWAY 6 STE 103
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4439
Practice Address - Country:US
Practice Address - Phone:713-457-4372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096782363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty