Healthcare Provider Details

I. General information

NPI: 1063331312
Provider Name (Legal Business Name): CHRISTIANA NDUKAIFE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 RIDGEMONT AVE APT 3107
CHARLOTTE NC
28208-0206
US

IV. Provider business mailing address

2304 RIDGEMONT AVE APT 3107
CHARLOTTE NC
28208-0206
US

V. Phone/Fax

Practice location:
  • Phone: 617-480-9615
  • Fax:
Mailing address:
  • Phone: 617-480-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number377054
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: