Provider Demographics
NPI:1801362876
Name:EZENNIA, GENEVIEVE OBIANUJU (FNP)
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:OBIANUJU
Last Name:EZENNIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:GENEVIEVE
Other - Middle Name:OBIANUJU
Other - Last Name:ADAOBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:350 POSADA LN STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4061
Mailing Address - Country:US
Mailing Address - Phone:805-434-3699
Mailing Address - Fax:805-434-4864
Practice Address - Street 1:350 POSADA LN STE 102
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4061
Practice Address - Country:US
Practice Address - Phone:805-434-3699
Practice Address - Fax:805-434-4864
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY