Healthcare Provider Details

I. General information

NPI: 1922092253
Provider Name (Legal Business Name): NNEMKA IJEOMA EKWUEME-STURDIVANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 RANDOLPH RD SUITE 220
CHARLOTTE NC
28207-1100
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-1125
  • Fax: 704-316-1127
Mailing address:
  • Phone: 704-316-1125
  • Fax: 704-316-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2004-01052
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: