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General NPI Number Information
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NPI Number | 1023661816
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Entity Type | Individual
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Provider Name | IRENE OBIAGERI IBENYENWA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/20/2019
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 1350 WOOTEN LAKE RD NW STE 204
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City | KENNESAW
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State | GA
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Zip | 30144-1346
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Country | US
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Telephone | 678-402-1389
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Fax | 678-737-1729
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Provider Business Mailing Address
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Address Line | 1350 WOOTEN LAKE RD NW STE 204
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City | KENNESAW
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State | GA
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Zip | 30144-1346
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Country | US
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Telephone | 678-390-4149
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Fax | 678-737-1729
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 184698
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License Number State | GA
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