Healthcare Provider Details

I. General information

NPI: 1023685021
Provider Name (Legal Business Name): HARRIETH AMAKA MADU PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 PLAZA DR STE 170
FOLSOM CA
95630-4790
US

IV. Provider business mailing address

510 PLAZA DR STE 170
FOLSOM CA
95630-4790
US

V. Phone/Fax

Practice location:
  • Phone: 916-351-9400
  • Fax: 916-351-9449
Mailing address:
  • Phone: 916-351-9400
  • Fax: 916-351-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95017392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: