Provider Demographics
NPI:1720550296
Name:IKEDINMA, NNEKA EZINWANNE
Entity Type:Individual
Prefix:
First Name:NNEKA
Middle Name:EZINWANNE
Last Name:IKEDINMA
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 1:881 3RD ST STE B5
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-5929
Mailing Address - Country:US
Mailing Address - Phone:610-776-9440
Mailing Address - Fax:610-776-9444
Practice Address - Street 1:881 3RD ST STE B5
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-5929
Practice Address - Country:US
Practice Address - Phone:610-776-9440
Practice Address - Fax:610-776-9444
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026562363LP0808X
PASP019813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily