Healthcare Provider Details

I. General information

NPI: 1346461431
Provider Name (Legal Business Name): NGOZI NNAJI NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NGOZI NNAJI FNP-C

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/26/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 WILD LAUREL CT
WAXHAW NC
28173-6101
US

IV. Provider business mailing address

307 WILD LAUREL CT
WAXHAW NC
28173-6101
US

V. Phone/Fax

Practice location:
  • Phone: 704-264-6208
  • Fax:
Mailing address:
  • Phone: 704-264-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License NumberHC3461
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5008979
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: