Provider Demographics
NPI:1104073303
Name:EZIMORAH, JANEFRANCES CHINWE
Entity type:Individual
Prefix:
First Name:JANEFRANCES
Middle Name:CHINWE
Last Name:EZIMORAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANEFRANCES
Other - Middle Name:CHINWE
Other - Last Name:ANARADOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3327 SUPERIOR LN STE 206
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1941
Mailing Address - Country:US
Mailing Address - Phone:240-206-8345
Mailing Address - Fax:240-245-3064
Practice Address - Street 1:3327 SUPERIOR LN STE 206
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1941
Practice Address - Country:US
Practice Address - Phone:240-206-8345
Practice Address - Fax:240-245-3064
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114571363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health