Provider Demographics
NPI:1427770940
Name:EZUMAH, AMARA JENEVIN (PMHNP MSN, RN)
Entity type:Individual
Prefix:MRS
First Name:AMARA
Middle Name:JENEVIN
Last Name:EZUMAH
Suffix:
Gender:F
Credentials:PMHNP MSN, RN
Other - Prefix:
Other - First Name:AMARA
Other - Middle Name:JENEVIN
Other - Last Name:EZEANIOMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1702 W 107TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4444
Mailing Address - Country:US
Mailing Address - Phone:323-476-2007
Mailing Address - Fax:
Practice Address - Street 1:1702 W 107TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-4444
Practice Address - Country:US
Practice Address - Phone:323-476-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022494363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health