Provider Demographics
NPI:1689051377
Name:EJIOFOR, OLIVE O (RN)
Entity Type:Individual
Prefix:MRS
First Name:OLIVE
Middle Name:O
Last Name:EJIOFOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 N. NELLIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3673
Mailing Address - Country:US
Mailing Address - Phone:702-459-7500
Mailing Address - Fax:702-476-2028
Practice Address - Street 1:1745 N. NELLIS BLVD
Practice Address - Street 2:STE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-3673
Practice Address - Country:US
Practice Address - Phone:702-459-7500
Practice Address - Fax:702-476-2028
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN43872163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse