Provider Demographics
NPI:1205602638
Name:PRESTIGE HEALTH SERVICES PLLC
Entity type:Organization
Organization Name:PRESTIGE HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ONYEJE
Authorized Official - Middle Name:
Authorized Official - Last Name:IJAOLA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:336-858-4625
Mailing Address - Street 1:411 PARKWAY ST STE C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1644
Mailing Address - Country:US
Mailing Address - Phone:336-858-4625
Mailing Address - Fax:
Practice Address - Street 1:411 PARKWAY ST STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1644
Practice Address - Country:US
Practice Address - Phone:336-858-4625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty