Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 11027 | NV |
NPI | 1598743254 |
---|---|
Provider Name | Echezona Edozie Ezeanolue |
First Address | Las Vegas, NV 89102-2325 |
Second Address | Las Vegas, NV 89109-2218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 17/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100506925 | (05) | NV |
BE8170526 | DEA (01) | NV |
CS13694 | STATE PHARMACY (01) | NV |
I41918 | (02) | NE |