Provider Demographics
NPI:1598938292
Name:IKEAKANAM, ROSELINE OKWUOSA (FNP)
Entity Type:Individual
Prefix:
First Name:ROSELINE
Middle Name:OKWUOSA
Last Name:IKEAKANAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2989 W ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4118
Mailing Address - Country:US
Mailing Address - Phone:770-932-4700
Mailing Address - Fax:
Practice Address - Street 1:2989 W ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4118
Practice Address - Country:US
Practice Address - Phone:770-932-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN132218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily