Provider Demographics
NPI:1811648876
Name:NWOKORO, IJEOMA TINA (PMHNP)
Entity type:Individual
Prefix:
First Name:IJEOMA
Middle Name:TINA
Last Name:NWOKORO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 MAITLAND DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1239
Mailing Address - Country:US
Mailing Address - Phone:443-813-4620
Mailing Address - Fax:
Practice Address - Street 1:105 SWITCHBACK ST
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6004
Practice Address - Country:US
Practice Address - Phone:443-813-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021186056363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2021186056OtherPMHMP