Provider Demographics
NPI:1881002566
Name:NWAEZE, IJEOMA EUGENIA (MSN, NP)
Entity type:Individual
Prefix:
First Name:IJEOMA
Middle Name:EUGENIA
Last Name:NWAEZE
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 GALLATREE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-0712
Mailing Address - Country:US
Mailing Address - Phone:919-906-2322
Mailing Address - Fax:919-872-1170
Practice Address - Street 1:1001 NAVAHO DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7335
Practice Address - Country:US
Practice Address - Phone:919-906-2322
Practice Address - Fax:919-872-1170
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007043363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health