Healthcare Provider Details

I. General information

NPI: 1437789757
Provider Name (Legal Business Name): ROSE I ONUOHA MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W KING ST
KINGS MOUNTAIN NC
28086-3393
US

IV. Provider business mailing address

PO BOX 265
WAXHAW NC
28173-1043
US

V. Phone/Fax

Practice location:
  • Phone: 704-730-8461
  • Fax:
Mailing address:
  • Phone: 704-408-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012753
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: