Provider Demographics
NPI:1104615707
Name:EZEAKUDO, PATRICIA OGHOGHO
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:OGHOGHO
Last Name:EZEAKUDO
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 1:2510 E DUPONT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1601
Mailing Address - Country:US
Mailing Address - Phone:260-432-4913
Mailing Address - Fax:260-969-6832
Practice Address - Street 1:2510 E DUPONT RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1601
Practice Address - Country:US
Practice Address - Phone:260-432-4913
Practice Address - Fax:260-969-6832
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016548A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71016548AOtherNURSING BOARD