Provider Demographics
NPI:1790208668
Name:EZENEKWE, UCHENNA BRIDGET (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:UCHENNA
Middle Name:BRIDGET
Last Name:EZENEKWE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:UCHE
Other - Middle Name:BRIDGET
Other - Last Name:EZENEKWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:700 E OGDEN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1398
Mailing Address - Country:US
Mailing Address - Phone:630-789-9785
Mailing Address - Fax:630-789-9798
Practice Address - Street 1:700 E OGDEN AVE STE 202
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1296
Practice Address - Country:US
Practice Address - Phone:630-789-9785
Practice Address - Fax:630-789-9798
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015844363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner