Provider Demographics
NPI:1902412745
Name:EZEOKOLI, OGECHUKWU
Entity Type:Individual
Prefix:
First Name:OGECHUKWU
Middle Name:
Last Name:EZEOKOLI
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 1:13708 COLGATE WAY APT 1311
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7425
Mailing Address - Country:US
Mailing Address - Phone:240-713-1689
Mailing Address - Fax:
Practice Address - Street 1:13708 COLGATE WAY APT 1311
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7425
Practice Address - Country:US
Practice Address - Phone:240-713-1689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00178907376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide