Provider Demographics
NPI:1285320697
Name:AHAM-IROETUGO, NNEOMA OGONNAYA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NNEOMA
Middle Name:OGONNAYA
Last Name:AHAM-IROETUGO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-5017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3801 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1301
Practice Address - Country:US
Practice Address - Phone:336-883-0029
Practice Address - Fax:336-883-0867
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5018579363LP0808X
NC288588163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health