Individual
KIKELOMO EJIOGU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2530 CAMP RD, FAR ROCKAWAY, NY 11691-2725
(917) 373-9143
(718) 241-1759
Mailing address
2530 CAMP RD, FAR ROCKAWAY, NY 11691-2725
(917) 373-9143
(718) 241-1759
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
F305040-1
NY
163WM0705X
Medical-Surgical Registered Nurse
Primary
526936-1
NY
Other
Enumeration date
09/17/2010
Last updated
09/17/2010
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