Provider Demographics
NPI:1639996721
Name:EZEANYAGU, CYRIL IFEANYI (FNP)
Entity type:Individual
Prefix:MR
First Name:CYRIL
Middle Name:IFEANYI
Last Name:EZEANYAGU
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 190TH PL
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3469
Mailing Address - Country:US
Mailing Address - Phone:773-936-1987
Mailing Address - Fax:
Practice Address - Street 1:303 E WACKER DR STE 1127
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5215
Practice Address - Country:US
Practice Address - Phone:217-766-2712
Practice Address - Fax:312-312-9644
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.030594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily