Healthcare Provider Details

I. General information

NPI: 1033492954
Provider Name (Legal Business Name): EMMANUEL OLUSHOLA ULOKO SR. PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SILAS CREEK PARKWAY FORSYTH MEDICAL CENTER
WINSTON-SALEM NC
27103
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-5000
  • Fax: 336-718-9847
Mailing address:
  • Phone: 336-277-1800
  • Fax: 336-277-9538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5005303
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number5005303
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5005303
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: