Healthcare Provider Details

I. General information

NPI: 1114392990
Provider Name (Legal Business Name): STELLA NWASOKA ADESOKAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2015
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 OLIVEWOOD DR
MERCED CA
95348-1210
US

IV. Provider business mailing address

1114 OLIVEWOOD DRIVE
MERED CA
93637-8649
US

V. Phone/Fax

Practice location:
  • Phone: 209-349-1896
  • Fax:
Mailing address:
  • Phone: 209-349-1896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: