Provider Demographics
NPI:1780383869
Name:AKUBUEZEIWUNZE, IJEOMA JOYCE (NP)
Entity type:Individual
Prefix:
First Name:IJEOMA
Middle Name:JOYCE
Last Name:AKUBUEZEIWUNZE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:IJEOMA
Other - Middle Name:
Other - Last Name:ONYEAGUSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 ELMHURST ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3328
Mailing Address - Country:US
Mailing Address - Phone:857-318-5531
Mailing Address - Fax:
Practice Address - Street 1:8 ELMHURST ST # 1
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3328
Practice Address - Country:US
Practice Address - Phone:857-318-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2323899163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse