Individual
IJEOMA MBANUZUE PERKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
105 NEWSOM ST STE 106, DURHAM, NC 27704-2197
(919) 321-0418
(919) 321-0401
Mailing address
105 NEWSOM ST STE 106, DURHAM, NC 27704-2197
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-02550
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NC1105O002
MEDICARE PTAN
NC
Enumeration date
09/21/2010
Last updated
04/07/2023
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