MEDICARE: MRS. CHARITY NNENNA IKPE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN171431	GA
2	163W00000X	Registered Nurse	RN171431	GA

General Provider Information

NPI Number	:	1881970879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARITY NNENNA IKPE FNP

Provider Business Mailing Address
First Line	:	2692 TRELLIS OAKS CT SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-5407
Country	:	US
Telephone Number	:	770-444-3915
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 CRUSE RD STE 103
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-3169
Country	:	US
Telephone Number	:	770-456-5666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2011
Last Update Date	:	06/10/2020

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