Provider Demographics
NPI:1710458096
Name:OKORONKWO, NNENNAYA OGBULORIE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:NNENNAYA
Middle Name:OGBULORIE
Last Name:OKORONKWO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6952 ABIGAIL LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5769
Mailing Address - Country:US
Mailing Address - Phone:909-333-1003
Mailing Address - Fax:
Practice Address - Street 1:9680 CITRUS AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-5571
Practice Address - Country:US
Practice Address - Phone:909-357-7600
Practice Address - Fax:909-357-7649
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010504363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health