Provider Demographics
NPI:1508617259
Name:WOLLOR, NUKU
Entity Type:Individual
Prefix:
First Name:NUKU
Middle Name:
Last Name:WOLLOR
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 1:2136 MALLARD WOODS PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1026
Mailing Address - Country:US
Mailing Address - Phone:704-449-8074
Mailing Address - Fax:
Practice Address - Street 1:2136 MALLARD WOODS PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1026
Practice Address - Country:US
Practice Address - Phone:704-449-8074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
NC570474253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care