MEDICARE: PEARL OPOKUA NYANOR NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	5010530	NC
2	363L00000X	Nurse Practitioner	5010530	NC

General Provider Information

NPI Number	:	1558605766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEARL OPOKUA NYANOR NP

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	980-488-4900
Fax Number	:	980-488-4905

Provider Business Practice Location Address
First Line	:	10905 PROVIDENCE RD W
Second Line	:	SUITE G200
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-1538
Country	:	US
Telephone Number	:	980-488-4900
Fax Number	:	980-488-4905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2012
Last Update Date	:	07/26/2024

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