Healthcare Provider Details

I. General information

NPI: 1225814577
Provider Name (Legal Business Name): IFEOMA CHARITY ILODIGWE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 W MORGAN ST
RALEIGH NC
27603-1613
US

IV. Provider business mailing address

9611 SWEETSPIRE AVE
SAINT JOHN IN
46373-8046
US

V. Phone/Fax

Practice location:
  • Phone: 704-905-3237
  • Fax:
Mailing address:
  • Phone: 704-905-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023003221
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: