Provider Demographics
NPI:1679191811
Name:OFORI, EVELYN Y (FNP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:Y
Last Name:OFORI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:Y
Other - Last Name:BOSOMPEMAA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 604050
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 HIGHLAND OAKS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7154
Practice Address - Country:US
Practice Address - Phone:336-646-7323
Practice Address - Fax:336-646-7787
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC5013690363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program