Provider Demographics
NPI:1467198960
Name:ANUGOM, GEORGIANA NKECHI (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:GEORGIANA
Middle Name:NKECHI
Last Name:ANUGOM
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 SAGE CT
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3380
Mailing Address - Country:US
Mailing Address - Phone:323-820-8704
Mailing Address - Fax:
Practice Address - Street 1:510 PLAZA DR STE 170
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4790
Practice Address - Country:US
Practice Address - Phone:916-351-9400
Practice Address - Fax:916-351-9449
Is Sole Proprietor?:No
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019409363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health