Provider Demographics
NPI:1073232724
Name:ODIM, NNEKA UGOCHI
Entity Type:Individual
Prefix:MRS
First Name:NNEKA
Middle Name:UGOCHI
Last Name:ODIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 SWIFT CREEK XING
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7287
Mailing Address - Country:US
Mailing Address - Phone:984-484-0225
Mailing Address - Fax:
Practice Address - Street 1:3500 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2567
Practice Address - Country:US
Practice Address - Phone:919-451-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016728363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care