Healthcare Provider Details

I. General information

NPI: 1730774530
Provider Name (Legal Business Name): NNEKA OTTAH IHEJETO FNP, APRN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 OAKSTONE CT
CONCORD CA
94521-5430
US

IV. Provider business mailing address

5412 OAKSTONE CT
CONCORD CA
94521-5430
US

V. Phone/Fax

Practice location:
  • Phone: 925-768-2910
  • Fax:
Mailing address:
  • Phone: 925-768-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016608
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL28712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: