Provider Demographics
NPI:1619699881
Name:EKATAH, IZEKU IZIEGBE (PMHNP)
Entity type:Individual
Prefix:
First Name:IZEKU
Middle Name:IZIEGBE
Last Name:EKATAH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13539 DEERWATER DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2843
Mailing Address - Country:US
Mailing Address - Phone:240-305-8594
Mailing Address - Fax:
Practice Address - Street 1:13539 DEERWATER DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2843
Practice Address - Country:US
Practice Address - Phone:240-305-8594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024193213363LP0808X, 163WP0808X
MDR228813363LP0808X, 163W00000X
DCRN1045884163W00000X, 163WP0808X
CA95404464163W00000X
DCNP1045884363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health