Healthcare Provider Details

I. General information

NPI: 1518721331
Provider Name (Legal Business Name): OBIAKU ELSIE OGBONNA NP
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

1801 SAINT ALBANS DR STE G
RALEIGH NC
27609-6286
US

IV. Provider business mailing address

3024 QUEENSLAND RD
RALEIGH NC
27614-7262
US

V. Phone/Fax

Practice location:
  • Phone: 919-606-8402
  • Fax:
Mailing address:
  • Phone: 919-606-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12230039
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: