Provider Demographics
NPI:1891119491
Name:EZEONU, THELMA (NP)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:
Last Name:EZEONU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13512 MARY BOWIE PKWY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9072
Mailing Address - Country:US
Mailing Address - Phone:301-532-7685
Mailing Address - Fax:
Practice Address - Street 1:1450 MERCANTILE LN STE 241
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5464
Practice Address - Country:US
Practice Address - Phone:301-532-7685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR198848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily