Provider Demographics
NPI:1730774530
Name:IHEJETO, NNEKA OTTAH (FNP, APRN, RN)
Entity type:Individual
Prefix:
First Name:NNEKA
Middle Name:OTTAH
Last Name:IHEJETO
Suffix:
Gender:F
Credentials:FNP, APRN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 OAKSTONE CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-5430
Mailing Address - Country:US
Mailing Address - Phone:925-768-2910
Mailing Address - Fax:
Practice Address - Street 1:5412 OAKSTONE CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-5430
Practice Address - Country:US
Practice Address - Phone:925-768-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL28712163WL0100X
CA95016608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty