Provider Demographics
NPI:1376384701
Name:KALU, NDUKWE BASSEY
Entity type:Individual
Prefix:MR
First Name:NDUKWE
Middle Name:BASSEY
Last Name:KALU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58218
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27658-8218
Mailing Address - Country:US
Mailing Address - Phone:919-649-3384
Mailing Address - Fax:919-457-1468
Practice Address - Street 1:8386 SIX FORKS RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5088
Practice Address - Country:US
Practice Address - Phone:919-649-3384
Practice Address - Fax:919-457-1468
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023153916363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health