Provider Demographics
NPI:1225814577
Name:ILODIGWE, IFEOMA CHARITY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:IFEOMA
Middle Name:CHARITY
Last Name:ILODIGWE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 OLEANDER LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-5005
Mailing Address - Country:US
Mailing Address - Phone:704-905-3237
Mailing Address - Fax:
Practice Address - Street 1:8501 TOWER POINT DR STE D2
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7853
Practice Address - Country:US
Practice Address - Phone:704-819-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023003221363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health