Provider Demographics
NPI:1437990926
Name:EZENWA, PRINCESS (NP)
Entity type:Individual
Prefix:
First Name:PRINCESS
Middle Name:
Last Name:EZENWA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 WEEPING FIG LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7118
Mailing Address - Country:US
Mailing Address - Phone:704-649-0027
Mailing Address - Fax:
Practice Address - Street 1:6700 WEST LOOP S
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4104
Practice Address - Country:US
Practice Address - Phone:281-393-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine