Provider Demographics
NPI:1841526142
Name:EZUKANMA, LAWRETTA NJIDEKA (RN)
Entity type:Individual
Prefix:
First Name:LAWRETTA
Middle Name:NJIDEKA
Last Name:EZUKANMA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9908 LAMBERTON TER
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8514
Mailing Address - Country:US
Mailing Address - Phone:817-980-5659
Mailing Address - Fax:817-562-2544
Practice Address - Street 1:9908 LAMBERTON TER
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8514
Practice Address - Country:US
Practice Address - Phone:817-980-5659
Practice Address - Fax:817-562-2544
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX719537163WA2000X
TX1146978363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator