Provider Demographics
NPI:1245775683
Name:EZEUGWA, ERINMA ONYEKACHI
Entity type:Individual
Prefix:
First Name:ERINMA
Middle Name:ONYEKACHI
Last Name:EZEUGWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERINMA
Other - Middle Name:ONYEKACHI
Other - Last Name:OBIOHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46156 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-5033
Mailing Address - Country:US
Mailing Address - Phone:248-897-0900
Mailing Address - Fax:
Practice Address - Street 1:46156 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-5033
Practice Address - Country:US
Practice Address - Phone:248-322-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704299407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily