Provider Demographics
NPI:1760771612
Name:NNAMENE, IJEOMA EUSTASIA
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:EUSTASIA
Last Name:NNAMENE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:IJEOMA
Other - Middle Name:EUSTASIA
Other - Last Name:ANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4909 ALPINIS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-1956
Mailing Address - Country:US
Mailing Address - Phone:919-741-4464
Mailing Address - Fax:919-741-4463
Practice Address - Street 1:4909 ALPINIS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-1956
Practice Address - Country:US
Practice Address - Phone:919-741-4464
Practice Address - Fax:919-741-4463
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care