Provider Demographics
NPI:1033828074
Name:IZUAKOR, IFEANYI
Entity type:Individual
Prefix:
First Name:IFEANYI
Middle Name:
Last Name:IZUAKOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 HIGH HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7796
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8396 SIX FORKS RD STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3058
Practice Address - Country:US
Practice Address - Phone:919-522-8956
Practice Address - Fax:984-202-2158
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC6770253Z00000X
NC211352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No253Z00000XAgenciesIn Home Supportive Care