Provider Demographics
NPI:1144583949
Name:NWADIGO, EZINNE
Entity type:Individual
Prefix:
First Name:EZINNE
Middle Name:
Last Name:NWADIGO
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 1:7826 EASTERN AVE NW
Mailing Address - Street 2:LL18A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1324
Mailing Address - Country:US
Mailing Address - Phone:202-722-7776
Mailing Address - Fax:202-722-7785
Practice Address - Street 1:7231 HANOVER PKWY STE A
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2027
Practice Address - Country:US
Practice Address - Phone:301-910-7209
Practice Address - Fax:301-982-2588
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MDR237641363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No374U00000XNursing Service Related ProvidersHome Health Aide