Healthcare Provider Details

I. General information

NPI: 1154185056
Provider Name (Legal Business Name): JENNA LEIGH ONOFRIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 HENDERSON DR
JACKSONVILLE NC
28546-0055
US

IV. Provider business mailing address

206 EMERALD RIDGE RD
JACKSONVILLE NC
28546-8766
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-6406
  • Fax: 910-482-5112
Mailing address:
  • Phone: 910-545-5073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number346686
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: