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General NPI Number Information
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NPI Number | 1801362876
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Entity Type | Individual
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Provider Name | GENEVIEVE OBIANUJU EZENNIA FNP
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Gender | Female
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 350 POSADA LN STE 102
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City | TEMPLETON
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State | CA
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Zip | 93465-4061
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Country | US
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Telephone | 805-434-3699
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Fax | 805-434-4864
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Provider Business Mailing Address
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Address Line | 350 POSADA LN STE 102
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City | TEMPLETON
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State | CA
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Zip | 93465-4061
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Country | US
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Telephone | 805-434-3699
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Fax | 805-434-4864
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95008869
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License Number State | CA
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