Provider Demographics
NPI:1497350946
Name:NWOKOLO, MERCY EBERE-MARTINS (NP)
Entity type:Individual
Prefix:
First Name:MERCY
Middle Name:EBERE-MARTINS
Last Name:NWOKOLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3083 ORDWAY DR NW APT G
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-1989
Mailing Address - Country:US
Mailing Address - Phone:832-876-0424
Mailing Address - Fax:
Practice Address - Street 1:3083 ORDWAY DR NW APT G
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-1989
Practice Address - Country:US
Practice Address - Phone:832-876-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179328363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health