Provider Demographics
NPI:1295903920
Name:EZIOLISA, OBIORA JOSEPH (LPN)
Entity type:Individual
Prefix:MR
First Name:OBIORA
Middle Name:JOSEPH
Last Name:EZIOLISA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 POPLAR GROVE DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2728
Mailing Address - Country:US
Mailing Address - Phone:937-626-3575
Mailing Address - Fax:937-280-4343
Practice Address - Street 1:535 POPLAR GROVE DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2728
Practice Address - Country:US
Practice Address - Phone:937-626-3575
Practice Address - Fax:937-280-4343
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 122566164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse