Provider Demographics
NPI:1699891192
Name:EZENWA, INNOCENT CHUKWUMA (MD)
Entity type:Individual
Prefix:DR
First Name:INNOCENT
Middle Name:CHUKWUMA
Last Name:EZENWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2115 GREEN VISTA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-8516
Mailing Address - Country:US
Mailing Address - Phone:775-557-4900
Mailing Address - Fax:775-557-7240
Practice Address - Street 1:2115 GREEN VISTA DR STE 101
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8516
Practice Address - Country:US
Practice Address - Phone:775-557-4900
Practice Address - Fax:775-557-7240
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT042-0012250207RS0012X
NV16000207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine