Provider Demographics
NPI:1134689532
Name:OKOCHA, IFUNANYA (NP)
Entity Type:Individual
Prefix:
First Name:IFUNANYA
Middle Name:
Last Name:OKOCHA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 ENGLAND ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5954
Mailing Address - Country:US
Mailing Address - Phone:704-551-4151
Mailing Address - Fax:704-551-4114
Practice Address - Street 1:7704 ENGLAND ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5954
Practice Address - Country:US
Practice Address - Phone:704-551-4151
Practice Address - Fax:704-551-4114
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine