Provider Demographics
NPI:1740525633
Name:EZIKPE, ISIS
Entity type:Individual
Prefix:
First Name:ISIS
Middle Name:
Last Name:EZIKPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4895 E RUSSELL RD APT 343
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4502
Mailing Address - Country:US
Mailing Address - Phone:702-423-5001
Mailing Address - Fax:
Practice Address - Street 1:4895 E RUSSELL RD APT 343
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4502
Practice Address - Country:US
Practice Address - Phone:702-423-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner