Provider Demographics
NPI:1164237400
Name:CREDOSTAR PSYCHIATRIC NURSING CORPORATION
Entity type:Organization
Organization Name:CREDOSTAR PSYCHIATRIC NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OSITA
Authorized Official - Middle Name:STELLA
Authorized Official - Last Name:NLEMCHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:832-904-6531
Mailing Address - Street 1:4719 QUAIL LAKES DR STE G1108
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8140
Mailing Address - Country:US
Mailing Address - Phone:832-904-6531
Mailing Address - Fax:
Practice Address - Street 1:4719 QUAIL LAKES DR STE G1108
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8140
Practice Address - Country:US
Practice Address - Phone:832-904-6531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty