Provider Demographics
NPI:1437622917
Name:IJEZIE, NIARA CHINYERE
Entity type:Individual
Prefix:
First Name:NIARA
Middle Name:CHINYERE
Last Name:IJEZIE
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 1:25 SHORES ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3047
Mailing Address - Country:US
Mailing Address - Phone:857-701-3344
Mailing Address - Fax:
Practice Address - Street 1:25 SHORES ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3047
Practice Address - Country:US
Practice Address - Phone:857-701-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator