Provider Demographics
NPI:1881457653
Name:EKPEMIRO, EZIHE AKUDO (CNS-BC, AGCNS)
Entity type:Individual
Prefix:
First Name:EZIHE
Middle Name:AKUDO
Last Name:EKPEMIRO
Suffix:
Gender:F
Credentials:CNS-BC, AGCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 TAZETTA DR
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-2496
Mailing Address - Country:US
Mailing Address - Phone:510-593-8690
Mailing Address - Fax:
Practice Address - Street 1:6040 TAZETTA DR
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-2496
Practice Address - Country:US
Practice Address - Phone:510-593-8690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA746918163W00000X
CA4999364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse