Healthcare Provider Details

I. General information

NPI: 1801136775
Provider Name (Legal Business Name): JENNIFER OSAGHAE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N AKERS ST UNIT 6821
VISALIA CA
93291
US

IV. Provider business mailing address

PO BOX 6821
VISALIA CA
93290-6821
US

V. Phone/Fax

Practice location:
  • Phone: 559-426-3536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19875
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95004948
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number95004948
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95004948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: