Healthcare Provider Details

I. General information

NPI: 1063686616
Provider Name (Legal Business Name): JENNIFER ONYEKONWU-MCGILL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MBANUGO PMHNP-BC, FNP-BC

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W BASELINE RD STE 3
CLAREMONT CA
91711-1612
US

IV. Provider business mailing address

2935 PARKSIDE AVE
ONTARIO CA
91761-6956
US

V. Phone/Fax

Practice location:
  • Phone: 909-625-7175
  • Fax: 909-625-7268
Mailing address:
  • Phone: 909-472-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number550923
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20417
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number20417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: