Individual provider Active NPI

Eyefujirin Endurance Ukponmwan, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Durham, NC
National Provider Identifier
1861080111
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5014299 Issued in NC
Practice address
2645 Meridian Pkwy Ste 323
Durham, NC 27713-4232
Phone
(984) 227-8902
NPI assigned
Jan 4, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 272678 NC
Family Nurse Practitioner 363LF0000X 5014299 NC Primary

Addresses

Primary practice location

2645 Meridian Pkwy Ste 323
Durham, NC 27713-4232

Mailing address

6840 Glenwood Ave
Raleigh, NC 27612-7133
Phone (919) 781-8604

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210716002748 NC Practitioner - Nurse Practitioner 1951703610 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
272678NCMDRegistered Nurse
5014299NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Concertocare Medical Group of North Carolina, PC CurrentSince Sep 6, 2024 Accepting new patients
Theoria Medical Past Accepting new patients

Locations

811 Main St
#7
Kansas City, MO 64105

2530 Meridian Pkwy
Ste 300
Durham, NC 27713
Phone (919) 443-1708

Interoperability endpoints

  • Direct secure messaging: eukponmwan@landmarkhealth-direct.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1609718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1861080111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6840 GLENWOOD AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276127133",
            "telephone_number": "919-781-8604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2645 MERIDIAN PKWY STE 323",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277134232",
            "telephone_number": "984-227-8902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UKPONMWAN",
        "first_name": "EYEFUJIRIN",
        "middle_name": "ENDURANCE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-04",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "272678",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5014299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.