Provider Demographics
NPI:1710753314
Name:EKAMA, YVONNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:EKAMA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:Y
Other - Last Name:OGHENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:626 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1706
Mailing Address - Country:US
Mailing Address - Phone:585-536-7617
Mailing Address - Fax:
Practice Address - Street 1:626 6TH ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1706
Practice Address - Country:US
Practice Address - Phone:585-536-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405606363LP0808X
NY352466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily