Provider Demographics
NPI:1689349698
Name:MORIKANG, PATIENCE ENNIH (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:PATIENCE
Middle Name:ENNIH
Last Name:MORIKANG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:PATIENCE
Other - Middle Name:ENNIH
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 W ROBINHOOD DR STE L
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5626
Mailing Address - Country:US
Mailing Address - Phone:844-867-8444
Mailing Address - Fax:
Practice Address - Street 1:1111 W ROBINHOOD DR STE L
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5626
Practice Address - Country:US
Practice Address - Phone:844-867-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2021040224363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health