Healthcare Provider Details

I. General information

NPI: 1578840476
Provider Name (Legal Business Name): PEACE ANYANWU OKOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 SEATON DR
FOLSOM CA
95630-7950
US

IV. Provider business mailing address

386 SEATON DR
FOLSOM CA
95630-7950
US

V. Phone/Fax

Practice location:
  • Phone: 916-792-4505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1004093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: