Healthcare Provider Details

I. General information

NPI: 1841701422
Provider Name (Legal Business Name): NHLANHLA MOYO PMHNP- BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 11/29/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 37TH STREET
SACRAMENTO CA
95824
US

IV. Provider business mailing address

6810 DI LUSSO DR APT 133
ELK GROVE CA
95758-5885
US

V. Phone/Fax

Practice location:
  • Phone: 916-210-8773
  • Fax: 916-395-5904
Mailing address:
  • Phone: 916-262-4890
  • Fax: 916-244-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95012918
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95012918
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95094023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: