Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95019652 | CA |
NPI | 1013669043 |
---|---|
Provider Name | Miss Jennifer N Okechukwu |
First Address | Los Angeles, CA 90017-2033 |
Second Address | Los Angeles, CA 90017-2033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2022 |
Last Update Date | 20/01/2022 |