Provider Demographics
NPI:1659242261
Name:EJIOGU, IJEOMA ANGELUSTER (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:IJEOMA
Middle Name:ANGELUSTER
Last Name:EJIOGU
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3064
Mailing Address - Country:US
Mailing Address - Phone:781-885-1481
Mailing Address - Fax:
Practice Address - Street 1:950 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3064
Practice Address - Country:US
Practice Address - Phone:781-885-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2289462363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health