Healthcare Provider Details

I. General information

NPI: 1356104764
Provider Name (Legal Business Name): FOWAD ADVANCED NURSING CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 WILLOW AVE STE 10
CLOVIS CA
93612-4715
US

IV. Provider business mailing address

3097 WILLOW AVE STE 10
CLOVIS CA
93612-4715
US

V. Phone/Fax

Practice location:
  • Phone: 831-208-4416
  • Fax:
Mailing address:
  • Phone: 831-208-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OGHOGHO UHUNMWANGHO
Title or Position: CEO
Credential: NP
Phone: 831-208-4416