Provider Demographics
NPI:1780321406
Name:EKANEM, INIOBONG
Entity type:Individual
Prefix:
First Name:INIOBONG
Middle Name:
Last Name:EKANEM
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 1:10006 ERION CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2843
Mailing Address - Country:US
Mailing Address - Phone:301-377-1127
Mailing Address - Fax:
Practice Address - Street 1:10006 ERION CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2843
Practice Address - Country:US
Practice Address - Phone:301-377-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A00172132376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide