Healthcare Provider Details

I. General information

NPI: 1700795929
Provider Name (Legal Business Name): EMPOWERED LIVING NURSING SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 BOISE AVE
MODESTO CA
95358-6948
US

IV. Provider business mailing address

1916 BOISE AVE
MODESTO CA
95358-6948
US

V. Phone/Fax

Practice location:
  • Phone: 864-980-2134
  • Fax: 209-758-0952
Mailing address:
  • Phone: 864-980-2134
  • Fax: 209-758-0952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL LAKE-AKINNUOYE
Title or Position: CEO
Credential: MSN, RN, FNP-C
Phone: 864-980-2134