Provider Demographics
NPI:1215745005
Name:EKUNWE, IZODUWA LUCINDA (NP)
Entity type:Individual
Prefix:MRS
First Name:IZODUWA
Middle Name:LUCINDA
Last Name:EKUNWE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:IZODUWA
Other - Middle Name:LUCINDA
Other - Last Name:EKUNWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:131 DUNLEITH WAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5456
Mailing Address - Country:US
Mailing Address - Phone:601-718-7008
Mailing Address - Fax:
Practice Address - Street 1:131 DUNLEITH WAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5456
Practice Address - Country:US
Practice Address - Phone:601-718-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS915702163WE0003X
MSF10240227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency