Healthcare Provider Details

I. General information

NPI: 1114706249
Provider Name (Legal Business Name): SABRINE A. ISHIMWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W ASH ST
GOLDSBORO NC
27530-1078
US

IV. Provider business mailing address

1543 BRIDLE CIR APT E
GREENVILLE NC
27834-6694
US

V. Phone/Fax

Practice location:
  • Phone: 919-947-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number275584
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: