Provider Demographics
NPI:1699472464
Name:EKEKE, CHARITY (RN)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:EKEKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5907 LAGUNA VILLA WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4705
Mailing Address - Country:US
Mailing Address - Phone:818-209-1147
Mailing Address - Fax:
Practice Address - Street 1:5907 LAGUNA VILLA WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4705
Practice Address - Country:US
Practice Address - Phone:916-509-9783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA454951163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse