Healthcare Provider Details

I. General information

NPI: 1841760170
Provider Name (Legal Business Name): CHIDINMA CYNTHIA UKAH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9394 BIG HORN BLVD
ELK GROVE CA
95758-7977
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-691-8500
  • Fax: 916-691-8585
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1157666
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95010240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: