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General NPI Number Information
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NPI Number | 1700795929
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Entity Type | Organization
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Legal Business Name | EMPOWERED LIVING NURSING SERVICES PC
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 1916 BOISE AVE
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City | MODESTO
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State | CA
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Zip | 95358-6948
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Country | US
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Telephone | 864-980-2134
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Fax | 209-758-0952
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Provider Business Mailing Address
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Address Line | 1916 BOISE AVE
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City | MODESTO
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State | CA
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Zip | 95358-6948
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Country | US
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Telephone | 864-980-2134
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Fax | 209-758-0952
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Authorized Official
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Title or Position | CEO
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Name | CRYSTAL LAKE-AKINNUOYE
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Credential | MSN, RN, FNP-C
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Telephone | 864-980-2134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | NULL
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