Healthcare Provider Details

I. General information

NPI: 1780211342
Provider Name (Legal Business Name): CHIOMA BLESSING EJIOGU NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 MURCHISON RD
FAYETTEVILLE NC
28301-3519
US

IV. Provider business mailing address

3500 STONEHAVEN DR
CHARLOTTE NC
28215-3232
US

V. Phone/Fax

Practice location:
  • Phone: 727-641-9107
  • Fax:
Mailing address:
  • Phone: 727-641-9107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27305
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP003261
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013224
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: