Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AG10170233 | NC |
NPI | 1013422344 |
---|---|
Provider Name | Roselyne Bonareri Onkundi |
First Address | Pembroke, NC 28372-7386 |
Second Address | Laurinburg, NC 28352-5502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2017 |
Last Update Date | 28/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013422344 | (05) | NC |
19UGN | BCBSNC (01) | NC |
A-G10170233 | AANP CERTIFICATION (01) | |
NN1072A | MEDICARE (01) | NC |