Healthcare Provider Details

I. General information

NPI: 1336843614
Provider Name (Legal Business Name): JOHN MAINA NYAGAH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 LONG WARF PL
SACRAMENTO CA
95835-2615
US

IV. Provider business mailing address

14 LONG WARF PL
SACRAMENTO CA
95835-2615
US

V. Phone/Fax

Practice location:
  • Phone: 302-563-6900
  • Fax:
Mailing address:
  • Phone: 302-563-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number722685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: