Individual
EKENEDILICHUKWU EZENWAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
7707 AUSTIN RD, STOCKTON, CA 95215-8312
(209) 467-8655
Mailing address
6713 SAO TIAGO WAY, ELK GROVE, CA 95757-3435
(323) 973-6970
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95030565
CA
Other
Enumeration date
06/14/2024
Last updated
06/14/2024
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