Provider Demographics
NPI:1578377404
Name:EZEKWE, EDITH IFEYINWA (RDN, ASCP,)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:IFEYINWA
Last Name:EZEKWE
Suffix:
Gender:F
Credentials:RDN, ASCP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-1622
Mailing Address - Country:US
Mailing Address - Phone:601-415-1249
Mailing Address - Fax:
Practice Address - Street 1:703 FARMER ST
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2319
Practice Address - Country:US
Practice Address - Phone:601-437-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS914536133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Single Specialty