Healthcare Provider Details

I. General information

NPI: 1114666021
Provider Name (Legal Business Name): IJEOMA NJOKU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 RIDGE AVE,
PHILADELPHIA PA
19128
US

IV. Provider business mailing address

224 FELTON AVE
SHARON HILL PA
19079-2105
US

V. Phone/Fax

Practice location:
  • Phone: 215-509-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP025263
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: