Kenneth Ezenwa
Nurse Practitioner - Psychiatric/Mental Health
17467 Honey Maple St
Canyon Country
, California 91387-6870
Kenneth Ezenwa
Nurse Practitioner - Psychiatric/Mental Health
17467 Honey Maple St
Canyon Country
, California 91387-6870
(661) 212-5273
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About
Features
Specialties
- Nurse Practitioner - Psychiatric/Mental Health
Languages spoken
- English
Location
First Address
- Kenneth Ezenwa
- 17467 Honey Maple St
- Canyon Country, CA
- Zip : 91387-6870
- Phone : (661) 212-5273
Second Address
- Kenneth Ezenwa
- 17467 Honey Maple St
- Canyon Country, CA
- Zip : 91387-6870
- Phone : (661) 212-5273
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95080178 | CA |
National Provider Identifier
| NPI | 1003379959 |
|---|---|
| Provider Name | Kenneth Ezenwa |
| First Address | Canyon Country, CA 91387-6870 |
| Second Address | Canyon Country, CA 91387-6870 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 08/04/2019 |
| Last Update Date | 08/02/2022 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.