Healthcare Provider Details

I. General information

NPI: 1821563073
Provider Name (Legal Business Name): AMAECHI GEORGE OZOR FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N CARPENTER RD STE D46
MODESTO CA
95351-1161
US

IV. Provider business mailing address

1620 N CARPENTER RD STE D46
MODESTO CA
95351-1161
US

V. Phone/Fax

Practice location:
  • Phone: 350-216-5774
  • Fax: 209-353-0479
Mailing address:
  • Phone: 350-216-5774
  • Fax: 209-353-0479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95051033
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number95010238
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number95010238
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95010238
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95010238
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number95010238
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: