Individual
IJEOMA TINA NWOKORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
105 SWITCHBACK ST, KNIGHTDALE, NC 27545-6004
(443) 813-4620
Mailing address
3513 MAITLAND DR, RALEIGH, NC 27610-1239
(443) 813-4620
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2021186056
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021186056
PMHMP
NC
Enumeration date
01/12/2022
Last updated
04/17/2023
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