Healthcare Provider Details

I. General information

NPI: 1780102996
Provider Name (Legal Business Name): STEPHANIE NNAMCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 06/26/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 MOUNTAIN RD NE STE 300
ALBUQUERQUE NM
87110-7840
US

IV. Provider business mailing address

300 COLONIAL CENTER PKWY STE 100
ALPHARETTA GA
30096-1287
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-1060
  • Fax: 505-416-4814
Mailing address:
  • Phone: 678-862-2513
  • Fax: 505-416-4814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN213609
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: