Healthcare Provider Details

I. General information

NPI: 1568078079
Provider Name (Legal Business Name): PATRICK OKECHUKWU ERONINI AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2020
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 MERCY CT STE B
FAIR OAKS CA
95628-3171
US

IV. Provider business mailing address

PO BOX 3091
MODESTO CA
95353-3091
US

V. Phone/Fax

Practice location:
  • Phone: 916-277-8881
  • Fax:
Mailing address:
  • Phone: 209-575-4575
  • Fax: 209-575-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030253
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1013975
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1013975
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1013975
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: