Healthcare Provider Details

I. General information

NPI: 1508477738
Provider Name (Legal Business Name): ONYEJE MAURA IJAOLA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N ELAM AVE STE E
GREENSBORO NC
27403-1129
US

IV. Provider business mailing address

411 PARKWAY ST STE C
GREENSBORO NC
27401-1644
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-1970
  • Fax: 336-832-1988
Mailing address:
  • Phone: 336-858-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013427
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: