Healthcare Provider Details

I. General information

NPI: 1225570898
Provider Name (Legal Business Name): VIVIAN UZOAMAKA ENYINNAYA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST
DURHAM NC
27705-3875
US

IV. Provider business mailing address

501 TEAL LAKE DR
HOLLY SPRINGS NC
27540-6046
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-0411
  • Fax: 919-286-0411
Mailing address:
  • Phone: 919-771-6994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1225570898
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: