Healthcare Provider Details

I. General information

NPI: 1700252434
Provider Name (Legal Business Name): CHIOMA OHIRI TAWOSE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHIOMA VICTORIA OHIRI FNP-BC

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 VILLAGE DR STE 201
FAYETTEVILLE NC
28304-4514
US

IV. Provider business mailing address

3505 VILLAGE DR STE 201
FAYETTEVILLE NC
28304-4514
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-0065
  • Fax:
Mailing address:
  • Phone: 910-323-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013587
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: