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General NPI Number Information
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NPI Number | 1124414750
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Entity Type | Individual
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Provider Name | COLLINS FOKUM FOMUNUNG FNP
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Gender | Male
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 1130 SAM NEWELL RD
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City | MATTHEWS
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State | NC
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Zip | 28105-5039
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Country | US
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Telephone | 704-900-7761
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Fax | 833-948-3597
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Provider Business Mailing Address
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Address Line | 1130 SAM NEWELL RD
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City | MATTHEWS
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State | NC
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Zip | 28105-5039
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Country | US
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Telephone | 704-900-7761
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Fax | 833-948-3597
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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 | 5007564
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License Number State | NC
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