Provider Demographics
NPI:1669075842
Name:EKE, PRINCEWILL C
Entity type:Individual
Prefix:
First Name:PRINCEWILL
Middle Name:C
Last Name:EKE
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 1:160 E VISTA RIDGE MALL DR APT 1436
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3730
Mailing Address - Country:US
Mailing Address - Phone:254-458-3747
Mailing Address - Fax:
Practice Address - Street 1:160 E VISTA RIDGE MALL DR APT 1436
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3730
Practice Address - Country:US
Practice Address - Phone:254-458-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse