MEDICARE: MINDROOT INTEGRATIVE PSYCHIATRIC NURSING CORPORATION

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

General Provider Information

NPI Number	:	1982538377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDROOT INTEGRATIVE PSYCHIATRIC NURSING CORPORATION

Provider Business Mailing Address
First Line	:	9629 FIRE STATION CT
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-8341
Country	:	US
Telephone Number	:	916-479-3316
Fax Number	:	916-479-3316

Provider Business Practice Location Address
First Line	:	9629 FIRE STATION CT
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-8341
Country	:	US
Telephone Number	:	916-479-3316
Fax Number	:	916-479-3316

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	CHINYERE JUNE ONWULI
Credential	:	DNP, PMHNP-BC
Telephone Number	:	916-479-3316

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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