Provider Demographics
NPI:1790382281
Name:BLUFF MEDICAL GROUP
Entity Type:Organization
Organization Name:BLUFF MEDICAL GROUP
Other - Org Name:BLUFF MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKEJI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, NP-C
Authorized Official - Phone:901-319-0743
Mailing Address - Street 1:PO BOX 17667
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-0667
Mailing Address - Country:US
Mailing Address - Phone:901-319-0743
Mailing Address - Fax:
Practice Address - Street 1:1779 KIRBY PARKWAY
Practice Address - Street 2:SUITE 1-212
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-319-0743
Practice Address - Fax:901-329-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty