Provider Demographics
NPI:1063686616
Name:ONYEKONWU-MCGILL, JENNIFER (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:ONYEKONWU-MCGILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MBANUGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC, FNP-BC
Mailing Address - Street 1:2935 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-6956
Mailing Address - Country:US
Mailing Address - Phone:909-472-6086
Mailing Address - Fax:
Practice Address - Street 1:540 W BASELINE RD STE 3
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-1612
Practice Address - Country:US
Practice Address - Phone:909-625-7175
Practice Address - Fax:909-625-7268
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550923163W00000X
CA20417363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily