Provider Demographics
NPI:1003411646
Name:NWIGWE, DESIREE C (APRN, PMHNP, PHN)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:C
Last Name:NWIGWE
Suffix:
Gender:F
Credentials:APRN, PMHNP, PHN
Other - Prefix:MS
Other - First Name:CHINENYENWA
Other - Middle Name:I
Other - Last Name:NJAKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, PMHNP, PHN
Mailing Address - Street 1:9990 COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3542
Mailing Address - Country:US
Mailing Address - Phone:951-358-4000
Mailing Address - Fax:
Practice Address - Street 1:9990 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3542
Practice Address - Country:US
Practice Address - Phone:951-358-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA800821163WG0000X
CA95016429363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice