Provider Demographics
NPI:1619699881
Name:EKATAH, IZEKU IZIEGBE (CRNP)
Entity type:Individual
Prefix:
First Name:IZEKU
Middle Name:IZIEGBE
Last Name:EKATAH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12774 WISTERIA DR # 353
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-9998
Mailing Address - Country:US
Mailing Address - Phone:240-813-0304
Mailing Address - Fax:641-206-7158
Practice Address - Street 1:333 HAWAII AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4966
Practice Address - Country:US
Practice Address - Phone:202-232-4270
Practice Address - Fax:202-232-4394
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1045884163W00000X, 163WP0808X
MDR228813163W00000X, 363LP0808X
CA95404464163W00000X
VA0024193213163WP0808X, 363LP0808X
DCNP1045884363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health