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General NPI Number Information
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NPI Number | 1710458096
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Entity Type | Individual
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Provider Name | NNENNAYA OGBULORIE OKORONKWO PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 9680 CITRUS AVE
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City | FONTANA
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State | CA
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Zip | 92335-5571
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Country | US
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Telephone | 909-357-7600
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Fax | 909-357-7649
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Provider Business Mailing Address
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Address Line | 6952 ABIGAIL LN
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City | FONTANA
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State | CA
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Zip | 92336-5769
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Country | US
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Telephone | 909-333-1003
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95010504
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License Number State | CA
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