Provider Demographics
NPI:1295138246
Name:EZEUME, OLUCHI L (DNP, AGNP-C)
Entity type:Individual
Prefix:DR
First Name:OLUCHI
Middle Name:L
Last Name:EZEUME
Suffix:
Gender:F
Credentials:DNP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 N SAGUARO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6242
Mailing Address - Country:US
Mailing Address - Phone:602-671-7990
Mailing Address - Fax:
Practice Address - Street 1:9700 N SAGUARO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6242
Practice Address - Country:US
Practice Address - Phone:602-671-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810623363L00000X
ARA004893363L00000X
AZAP11482363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner