Healthcare Provider Details

I. General information

NPI: 1235097221
Provider Name (Legal Business Name): WILBERFORCE NDYANABO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 MCLAREN DR
REDDING CA
96002-9845
US

IV. Provider business mailing address

5011 MCLAREN DR
REDDING CA
96002-9845
US

V. Phone/Fax

Practice location:
  • Phone: 805-440-2380
  • Fax:
Mailing address:
  • Phone: 805-440-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN95286733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: