=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114392990
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STELLA NWASOKA ADESOKAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2015
-----------------------------------------------------
Last Update Date | 10/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1114 OLIVEWOOD DR
-----------------------------------------------------
City | MERCED
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95348-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-349-1896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1114 OLIVEWOOD DRIVE
-----------------------------------------------------
City | MERED
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93637-8649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-349-1896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95003522
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------