Healthcare Provider Details

I. General information

NPI: 1659763506
Provider Name (Legal Business Name): ADAEZE NKEIRUKA NWANONENYI DNP, FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

IV. Provider business mailing address

808 W 58TH ST
LOS ANGELES CA
90037-3632
US

V. Phone/Fax

Practice location:
  • Phone: 310-627-5850
  • Fax:
Mailing address:
  • Phone: 323-541-1600
  • Fax: 323-541-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95001860
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: