Provider Demographics
NPI:1992269146
Name:EZEANYA, OBIAGELI CHRISTIANA (FNP)
Entity type:Individual
Prefix:
First Name:OBIAGELI
Middle Name:CHRISTIANA
Last Name:EZEANYA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6481 ROYAL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2057
Mailing Address - Country:US
Mailing Address - Phone:313-729-3970
Mailing Address - Fax:
Practice Address - Street 1:6481 ROYAL POINTE DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2057
Practice Address - Country:US
Practice Address - Phone:313-729-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704233690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704233690OtherFAMILY NURSE PRACTITIONER/ REGISTERED NURSE