Individual
JOHNSON EZEBUIRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3840 HULEN ST, FORT WORTH, TX 76107-7277
(817) 335-3022
Mailing address
PO BOX 2603, FORT WORTH, TX 76113-2603
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
326400
TX
Other
Enumeration date
03/07/2022
Last updated
03/14/2022
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