Provider Demographics
NPI:1770202228
Name:EZIRIM, CHIEBONAM (RN)
Entity type:Individual
Prefix:
First Name:CHIEBONAM
Middle Name:
Last Name:EZIRIM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3184 W BROAD ST STE D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-1327
Mailing Address - Country:US
Mailing Address - Phone:614-279-8075
Mailing Address - Fax:614-279-8574
Practice Address - Street 1:3184 W BROAD ST STE D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-1327
Practice Address - Country:US
Practice Address - Phone:614-279-8075
Practice Address - Fax:614-279-8574
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN321371163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN321371OtherOHIO BOARD OF NURSING