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General NPI Number Information
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NPI Number | 1457960700
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Entity Type | Individual
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Provider Name | MAUREEN NWANYIBUIFE NNOKA
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Gender | Female
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 1901 CHURCH LN
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City | SAN PABLO
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State | CA
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Zip | 94806-3707
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Country | US
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Telephone | 510-236-3139
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 LUPINE CT
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City | SAN PABLO
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State | CA
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Zip | 94806-1879
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Country | US
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Telephone | 510-932-3243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 817858
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95023396
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License Number State | CA
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