Healthcare Provider Details

I. General information

NPI: 1982538377
Provider Name (Legal Business Name): MINDROOT INTEGRATIVE PSYCHIATRIC NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9629 FIRE STATION CT
ELK GROVE CA
95757-8341
US

IV. Provider business mailing address

9629 FIRE STATION CT
ELK GROVE CA
95757-8341
US

V. Phone/Fax

Practice location:
  • Phone: 916-479-3316
  • Fax: 916-479-3316
Mailing address:
  • Phone: 916-479-3316
  • Fax: 916-479-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHINYERE JUNE ONWULI
Title or Position: OWNER/PRESIDENT
Credential: DNP, PMHNP-BC
Phone: 916-479-3316