Provider Demographics
NPI:1790107464
Name:EZEH, NJIDEKA LYNDA (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:NJIDEKA
Middle Name:LYNDA
Last Name:EZEH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:NJIDEKA
Other - Middle Name:
Other - Last Name:OSUALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108
Mailing Address - Country:US
Mailing Address - Phone:816-234-8809
Mailing Address - Fax:816-234-3494
Practice Address - Street 1:2401 GILLHAM ROAD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:816-234-8809
Practice Address - Fax:816-234-3494
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013040014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily