Provider Demographics
NPI:1003652348
Name:OSUNWOKE, VIVIANMARY UDOKA (DNP/FNP, MHA, BSN,RN)
Entity type:Individual
Prefix:DR
First Name:VIVIANMARY
Middle Name:UDOKA
Last Name:OSUNWOKE
Suffix:
Gender:F
Credentials:DNP/FNP, MHA, BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 W LINCOLN AVE APT 216
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6511
Mailing Address - Country:US
Mailing Address - Phone:714-678-7382
Mailing Address - Fax:
Practice Address - Street 1:2414 S FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5318
Practice Address - Country:US
Practice Address - Phone:714-641-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty