Healthcare Provider Details

I. General information

NPI: 1508600248
Provider Name (Legal Business Name): ONYIYECHI PEACE ROSEAU DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10348 PARK RD
CHARLOTTE NC
28210-8507
US

IV. Provider business mailing address

10348 PARK RD
CHARLOTTE NC
28210-8507
US

V. Phone/Fax

Practice location:
  • Phone: 704-741-4813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024118
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28789
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: