Healthcare Provider Details

I. General information

NPI: 1750929519
Provider Name (Legal Business Name): ROSEDELIA CHINYERE OKORO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSEDELIA CHINYERE MADU NP

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2398
US

IV. Provider business mailing address

5329 JADE FOREST TRL
RALEIGH NC
27616-5148
US

V. Phone/Fax

Practice location:
  • Phone: 919-956-4000
  • Fax:
Mailing address:
  • Phone: 919-327-8705
  • Fax: 919-327-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5014640
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: