Individual
DR. CHINOMSO D EZENWATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
3110 S DURANGO DR STE 200, LAS VEGAS, NV 89117
(702) 415-9760
(702) 478-6211
Mailing address
PO BOX 30771, LAS VEGAS, NV 89173-0771
(702) 159-7604
(702) 478-6211
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN001829
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851785828
—
NV
Enumeration date
03/26/2015
Last updated
09/22/2021
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