=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366177123
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN ONORI FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2022
-----------------------------------------------------
Last Update Date | 07/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2601 LAKE DR STE 301
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-6689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-782-5911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 HIGHVIEW DR
-----------------------------------------------------
City | YOUNGSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27596-7914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-760-9089
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5016541
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------