Healthcare Provider Details

I. General information

NPI: 1720794654
Provider Name (Legal Business Name): ERIAM SOLOME NNAMALIRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 DEWEY DRIVE
FAIR OAKS CA
95628
US

IV. Provider business mailing address

5025 FANDANGO LOOP
ROSEVILLE CA
95747-4375
US

V. Phone/Fax

Practice location:
  • Phone: 916-470-4060
  • Fax:
Mailing address:
  • Phone: 916-470-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95024790
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number722206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: