Healthcare Provider Details

I. General information

NPI: 1861080111
Provider Name (Legal Business Name): EYEFUJIRIN ENDURANCE UKPONMWAN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 MERIDIAN PKWY STE 323
DURHAM NC
27713-4232
US

IV. Provider business mailing address

6840 GLENWOOD AVE
RALEIGH NC
27612-7133
US

V. Phone/Fax

Practice location:
  • Phone: 984-227-8902
  • Fax:
Mailing address:
  • Phone: 919-781-8604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number272678
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014299
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: