Provider Demographics
NPI:1780008102
Name:NWABUNOR, MARY NWAKAGGO (NURSE PRACTITIONER ()
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NWAKAGGO
Last Name:NWABUNOR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER (
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 SAWYERS BAR LANE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973
Mailing Address - Country:US
Mailing Address - Phone:530-228-4295
Mailing Address - Fax:
Practice Address - Street 1:680 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2213
Practice Address - Country:US
Practice Address - Phone:530-342-4395
Practice Address - Fax:530-894-2325
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000302363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health