Provider Demographics
NPI:1679673511
Name:NWOKO, AGNES IHECHINYERE (NP)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:IHECHINYERE
Last Name:NWOKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:IHECHINYERE
Other - Last Name:OHAJUNWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1630
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28370-1630
Mailing Address - Country:US
Mailing Address - Phone:910-295-6007
Mailing Address - Fax:910-215-0179
Practice Address - Street 1:2014 ANTHONY RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8941
Practice Address - Country:US
Practice Address - Phone:336-506-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRN132950163WG0000X
NC5002926363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2005009938-22OtherANCC CERTIFICATION
NC2005009938-22OtherANCC CERTIFICATION