Provider Demographics
NPI:1780456657
Name:EZIRIM, EKELE ADAEZE
Entity type:Individual
Prefix:
First Name:EKELE
Middle Name:ADAEZE
Last Name:EZIRIM
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 1:4534 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-4355
Mailing Address - Country:US
Mailing Address - Phone:719-314-8789
Mailing Address - Fax:
Practice Address - Street 1:4534 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-4355
Practice Address - Country:US
Practice Address - Phone:719-314-8789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112765363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care