Provider Demographics
NPI:1407466824
Name:OFOEMEZIE, THERESA UJU (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:UJU
Last Name:OFOEMEZIE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S SAN AGUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8581
Mailing Address - Country:US
Mailing Address - Phone:678-557-1662
Mailing Address - Fax:
Practice Address - Street 1:250 S SAN AGUSTIN DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8581
Practice Address - Country:US
Practice Address - Phone:704-508-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012832363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health