Healthcare Provider Details

I. General information

NPI: 1134689532
Provider Name (Legal Business Name): IFUNANYA OKOCHA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7704 ENGLAND ST
CHARLOTTE NC
28273-5954
US

IV. Provider business mailing address

7704 ENGLAND ST
CHARLOTTE NC
28273-5954
US

V. Phone/Fax

Practice location:
  • Phone: 704-551-4151
  • Fax: 704-551-4114
Mailing address:
  • Phone: 704-551-4151
  • Fax: 704-551-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5011520
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: