Provider Demographics
NPI:1003680794
Name:EWUZIE, HENRIETTA AMAKA (NP)
Entity type:Individual
Prefix:MRS
First Name:HENRIETTA
Middle Name:AMAKA
Last Name:EWUZIE
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 1:14 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-1965
Mailing Address - Country:US
Mailing Address - Phone:857-233-1890
Mailing Address - Fax:
Practice Address - Street 1:14 HERITAGE CT
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-1965
Practice Address - Country:US
Practice Address - Phone:857-233-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2331615363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty