MEDICARE: OLIVE NKECHI GARNETT 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	363LF0000X	Family Nurse Practitioner	95010798	CA

General Provider Information

NPI Number	:	1922647668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVE NKECHI GARNETT NP

Provider Business Mailing Address
First Line	:	771 W 21ST STREET APT 4
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731
Country	:	US
Telephone Number	:	310-404-6562
Fax Number	:

Provider Business Practice Location Address
First Line	:	11149 CRENSHAW BLVD
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90303-2338
Country	:	US
Telephone Number	:	310-677-4600
Fax Number	:

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

Provider Enumeration Date	:	12/28/2019
Last Update Date	:	12/28/2019

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