MEDICARE: AILEEN NEEQUAYE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95024241	CA
2	363LF0000X	Family Nurse Practitioner	95024241	CA

General Provider Information

NPI Number	:	1831896794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILEEN NEEQUAYE NP

Provider Business Mailing Address
First Line	:	4100 TRUXTUN AVE
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-0678
Country	:	US
Telephone Number	:	661-632-1540
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 TRUXTUN AVE
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-0678
Country	:	US
Telephone Number	:	661-632-1540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	11/10/2024

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