Provider Demographics
NPI:1497838924
Name:ENUNWA, RITA O (RN, NP)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:O
Last Name:ENUNWA
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 N SONORA AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-3965
Mailing Address - Country:US
Mailing Address - Phone:559-276-7558
Mailing Address - Fax:559-276-7568
Practice Address - Street 1:4705 N SONORA AVE STE 113
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3965
Practice Address - Country:US
Practice Address - Phone:559-276-7558
Practice Address - Fax:559-276-7568
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP14955363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN566408Medicaid