Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 30101 | TX |
NPI | 1003446451 |
---|---|
Provider Name | Ifeoma Nneka Mozie |
First Address | Muskogee, OK 74401-4915 |
Second Address | Muskogee, OK 74401-4915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2020 |
Last Update Date | 23/01/2020 |