Provider Demographics
NPI:1205334752
Name:EJERE, MAURICE CHUKWUDI
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:CHUKWUDI
Last Name:EJERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 VIRGINIA WATER DR
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9215
Mailing Address - Country:US
Mailing Address - Phone:919-601-7672
Mailing Address - Fax:
Practice Address - Street 1:2700 NAGAMI CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-5889
Practice Address - Country:US
Practice Address - Phone:919-601-7672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC184968163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management