Healthcare Provider Details

I. General information

NPI: 1982009007
Provider Name (Legal Business Name): NKEIRUKA IHUNNA MAUREEN ABANOBI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W FERN AVE
REDLANDS CA
92373-5916
US

IV. Provider business mailing address

PO BOX 10069
SAN BERNARDINO CA
92423-0069
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-4188
  • Fax:
Mailing address:
  • Phone: 909-335-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number95001645
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95001645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: