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General NPI Number Information
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NPI Number | 1992309561
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Entity Type | Individual
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Provider Name | AMARACHI CHINWENDU IHEMEDU
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Gender | Female
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 1809 W REDLANDS BLVD STE 103
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City | REDLANDS
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State | CA
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Zip | 92373-8054
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Country | US
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Telephone | 909-335-3026
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Fax |
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Provider Business Mailing Address
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Address Line | 26610 BONITA HEIGHTS AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4226
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Country | US
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Telephone | 909-244-7778
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95122487
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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 | 95021606
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License Number State | CA
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