MEDICARE: SAMUEL NYAMU

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	163W00000X	Registered Nurse	739381	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	739381	OTHER	CA	NURSING

General Provider Information

NPI Number	:	1912639725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL NYAMU

Provider Business Mailing Address
First Line	:	4982 KOKOMO DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-1806
Country	:	US
Telephone Number	:	209-603-2404
Fax Number	:

Provider Business Practice Location Address
First Line	:	4982 KOKOMO DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-1806
Country	:	US
Telephone Number	:	209-603-2404
Fax Number	:

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

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	09/11/2022

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Directions to “ SAMUEL NYAMU ” Practice Location

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