Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 5005303 | NC |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5005303 | NC |
NPI | 1033492954 |
---|---|
Provider Name | Emmanuel Olushola Uloko SR. |
First Address | Charlotte, NC 28260-0447 |
Second Address | Winston-Salem, NC 27103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2011 |
Last Update Date | 30/03/2020 |