Provider Demographics
NPI:1518737071
Name:ENABULELE, FATE
Entity Type:Individual
Prefix:
First Name:FATE
Middle Name:
Last Name:ENABULELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 LONGWALK DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1719
Mailing Address - Country:US
Mailing Address - Phone:510-383-0895
Mailing Address - Fax:
Practice Address - Street 1:6580 LONGWALK DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-1719
Practice Address - Country:US
Practice Address - Phone:510-383-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA780085163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse