Healthcare Provider Details

I. General information

NPI: 1487498754
Provider Name (Legal Business Name): SOMGOLIE OZODIGWE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 RANDALL PKWY STE 105
WILMINGTON NC
28403-2565
US

IV. Provider business mailing address

3205 RANDALL PKWY STE 105
WILMINGTON NC
28403-2565
US

V. Phone/Fax

Practice location:
  • Phone: 910-742-9243
  • Fax:
Mailing address:
  • Phone: 910-557-0919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5020350
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC006764
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number327636
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: