Provider Demographics
NPI:1649588989
Name:PERKINS, IJEOMA MBANUZUE (PA-C)
Entity type:Individual
Prefix:
First Name:IJEOMA
Middle Name:MBANUZUE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:IJEOMA
Other - Middle Name:J
Other - Last Name:MBANUZUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:105 NEWSOM ST STE 106
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2197
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 NEWSOM ST STE 106
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2197
Practice Address - Country:US
Practice Address - Phone:919-321-0418
Practice Address - Fax:919-321-0401
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02550363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC1105O002OtherMEDICARE PTAN
NCNC1105AMedicare PIN