Provider Demographics
NPI:1902375116
Name:ONWUKANJO, EZIOMA C
Entity Type:Individual
Prefix:
First Name:EZIOMA
Middle Name:C
Last Name:ONWUKANJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HUNTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17406-6022
Mailing Address - Country:US
Mailing Address - Phone:717-793-6240
Mailing Address - Fax:
Practice Address - Street 1:215 HUNTER CREEK DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-6022
Practice Address - Country:US
Practice Address - Phone:717-793-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP19612163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP19612OtherLICENSE NUMBER