Provider Demographics
NPI:1861258105
Name:ETOAMAIHE, DAVIDSON OKECHUKWU (NP)
Entity type:Individual
Prefix:
First Name:DAVIDSON
Middle Name:OKECHUKWU
Last Name:ETOAMAIHE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 ST PAULS WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3390
Mailing Address - Country:US
Mailing Address - Phone:832-904-2349
Mailing Address - Fax:
Practice Address - Street 1:2344 ST PAULS WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3390
Practice Address - Country:US
Practice Address - Phone:832-904-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028981363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health