Provider Demographics
NPI:1578397493
Name:EKEANYANWU, UCHENNA (PMHNP)
Entity type:Individual
Prefix:
First Name:UCHENNA
Middle Name:
Last Name:EKEANYANWU
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23607 BATEY AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1206
Mailing Address - Country:US
Mailing Address - Phone:562-330-8890
Mailing Address - Fax:
Practice Address - Street 1:23607 BATEY AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-1206
Practice Address - Country:US
Practice Address - Phone:562-330-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95212199363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health