Provider Demographics
NPI:1023661816
Name:IBENYENWA, IRENE OBIAGERI (FNP-C)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:OBIAGERI
Last Name:IBENYENWA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 WOOTEN LAKE RD NW STE 204
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1346
Mailing Address - Country:US
Mailing Address - Phone:678-402-1389
Mailing Address - Fax:678-737-1729
Practice Address - Street 1:1350 WOOTEN LAKE RD NW STE 204
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1346
Practice Address - Country:US
Practice Address - Phone:678-402-1389
Practice Address - Fax:678-737-1729
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-20
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA184698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily