Provider Demographics
NPI:1710441613
Name:EJIOFOR, VIVIEN AMARACHI
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:AMARACHI
Last Name:EJIOFOR
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 1:7221 REAL QUIET DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4131
Mailing Address - Country:US
Mailing Address - Phone:702-327-0010
Mailing Address - Fax:
Practice Address - Street 1:1745 N NELLIS BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-3673
Practice Address - Country:US
Practice Address - Phone:702-280-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV829730163W00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant