Provider Demographics
NPI:1982305033
Name:EZETE, EZINNE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:EZINNE
Middle Name:
Last Name:EZETE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ZINNY
Other - Middle Name:
Other - Last Name:EZETE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:200 GLOVER AVE APT 241
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4515
Mailing Address - Country:US
Mailing Address - Phone:860-548-6603
Mailing Address - Fax:
Practice Address - Street 1:200 GLOVER AVE APT 241
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-4515
Practice Address - Country:US
Practice Address - Phone:860-548-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health