Healthcare Provider Details

I. General information

NPI: 1891193694
Provider Name (Legal Business Name): MARCELLINA NWOSU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E TACHEVAH DR STE 2E204
PALM SPRINGS CA
92262-5737
US

IV. Provider business mailing address

555 E TACHEVAH DR STE 2E204
PALM SPRINGS CA
92262-5737
US

V. Phone/Fax

Practice location:
  • Phone: 575-395-7246
  • Fax:
Mailing address:
  • Phone: 760-561-7344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP-55239
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: