Healthcare Provider Details

I. General information

NPI: 1427756139
Provider Name (Legal Business Name): NGOZI NADIA WEDDERBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 07/09/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 N CHURCH ST
GREENSBORO NC
27401-1007
US

IV. Provider business mailing address

3002 GREYSTONE PT UNIT M
GREENSBORO NC
27410-8944
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-4400
  • Fax:
Mailing address:
  • Phone: 919-523-9410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5018275
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: