Healthcare Provider Details

I. General information

NPI: 1053825224
Provider Name (Legal Business Name): STELLA ONYEAKAZI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STELLA UGORJI

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 7TH ST. NE- ALTRU CLINIC DEVILS LAKE
DEVILS LAKE ND
58301-2719
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-2157
  • Fax:
Mailing address:
  • Phone: 701-780-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR47975
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135739
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: