Provider Demographics
NPI:1316588668
Name:AVEGNO, KOMLANVI SEDO (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KOMLANVI
Middle Name:SEDO
Last Name:AVEGNO
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1007
Mailing Address - Country:US
Mailing Address - Phone:336-832-4435
Mailing Address - Fax:
Practice Address - Street 1:3940 ARROWHEAD BLVD STE 110
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7637
Practice Address - Country:US
Practice Address - Phone:336-832-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8531363LF0000X
NC5013420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily