| NPI | 1164880001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHINOMSO D EZENWATA President / Provider 702-415-9760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001829) |
| Enumeration Date | 2016-02-06 |
| Last Update Date | 2021-09-04 |