Provider Demographics
NPI:1922281153
Name:EJIGU, MEAZA
Entity Type:Individual
Prefix:MRS
First Name:MEAZA
Middle Name:
Last Name:EJIGU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEAZA
Other - Middle Name:
Other - Last Name:EJIGU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 11433
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0008
Mailing Address - Country:US
Mailing Address - Phone:480-299-3627
Mailing Address - Fax:602-671-6997
Practice Address - Street 1:64 E BROADWAY RD STE 200
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1377
Practice Address - Country:US
Practice Address - Phone:480-372-4135
Practice Address - Fax:602-671-6997
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2894363LP0808X, 363LF0000X, 363LP0808X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology