Provider Demographics
NPI:1578365953
Name:EZEOFOR, LOTANNA
Entity type:Individual
Prefix:
First Name:LOTANNA
Middle Name:
Last Name:EZEOFOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11229 219TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2649
Mailing Address - Country:US
Mailing Address - Phone:347-784-2392
Mailing Address - Fax:
Practice Address - Street 1:11229 219TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2649
Practice Address - Country:US
Practice Address - Phone:347-784-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program