Healthcare Provider Details

I. General information

NPI: 1689389942
Provider Name (Legal Business Name): NICOLE NJIKE NJOMU NJIKE EPSE BOBGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 E CARTWRIGHT AVE
FRESNO CA
93725-9385
US

IV. Provider business mailing address

257 N LAVERNE AVE
FRESNO CA
93727-6075
US

V. Phone/Fax

Practice location:
  • Phone: 559-498-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95147707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: