Individual
AGNES OLAOLU EZEKIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1545 HARBECK RD, GRANTS PASS, OR 97527-5605
(541) 476-2373
Mailing address
PO BOX 1231, HAVRE, MT 59501-1231
(406) 262-1302
(406) 265-1651
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
162006
MT
Other
Enumeration date
02/07/2020
Last updated
12/19/2023
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