Provider Demographics
NPI:1588091276
Name:EZEAMAMA, AYO RENEE (MSN)
Entity type:Individual
Prefix:MS
First Name:AYO
Middle Name:RENEE
Last Name:EZEAMAMA
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 BERING DR APT 609
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-3729
Mailing Address - Country:US
Mailing Address - Phone:618-203-3272
Mailing Address - Fax:
Practice Address - Street 1:400 PARK LN
Practice Address - Street 2:SUITE M
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506
Practice Address - Country:US
Practice Address - Phone:832-658-5230
Practice Address - Fax:713-473-0385
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010758363LF0000X
TXAP126407363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3491375Medicaid