Jacqueline Fungayi Mawoneke, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5009596 Issued in NC

Practice address

1100 E Wendover Ave
Greensboro, NC 27405-6713

Phone

(336) 641-6124

NPI assigned

Jun 20, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmawoneke@randolphprimarycare.gwaydirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Randolph Primary Care, PA

  • Durable Medical Equipment & Medical Supplies
  • Asheboro, NC
  • NPI 1528392289
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1114457314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E WENDOVER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056713",
            "fax_number": "336-641-8003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E WENDOVER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056713",
            "telephone_number": "336-641-6124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAWONEKE",
        "first_name": "JACQUELINE",
        "middle_name": "FUNGAYI",
        "name_prefix": "Dr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-20",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "MD",
            "license": "NC5009506",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5009596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Matthews
• Michael T Mattingly, MD
• Rebecca Murrell Mattocks, PT
• Christopher Alan Mauer
• Maurice K. Kpeglo (First Aid Emergency Clinic)
• Teresita Maxey, LCSW
• Maxim Habilitation Services, LLC
• Maxim Healthcare Services, Inc
• Maxim Healthcare Services, Inc.
• Maxwell Home Care Services LLC

• Nurse Practitioner in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.