Provider Demographics
NPI:1417559907
Name:OSUALA, EUDORA KRYSTLE, NNEKA (MSN, RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:EUDORA
Middle Name:KRYSTLE, NNEKA
Last Name:OSUALA
Suffix:
Gender:F
Credentials:MSN, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 ORANGE AVE UNIT 903
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1458
Mailing Address - Country:US
Mailing Address - Phone:310-956-5955
Mailing Address - Fax:
Practice Address - Street 1:10841 WHITE OAK AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3817
Practice Address - Country:US
Practice Address - Phone:909-581-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2017846363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health