Healthcare Provider Details

I. General information

NPI: 1922802404
Provider Name (Legal Business Name): EDDAH GICHUKI REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4604 BRIARWOOD DR
SACRAMENTO CA
95821-4108
US

IV. Provider business mailing address

4604 BRIARWOOD DR
SACRAMENTO CA
95821-4108
US

V. Phone/Fax

Practice location:
  • Phone: 404-725-0970
  • Fax:
Mailing address:
  • Phone: 404-725-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95110001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: