Provider Demographics
NPI:1821756578
Name:AMADASUN, FLORA OSASOGIE (LVN)
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:OSASOGIE
Last Name:AMADASUN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7841 BONNY DOWNS WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6572
Mailing Address - Country:US
Mailing Address - Phone:916-667-6511
Mailing Address - Fax:
Practice Address - Street 1:7841 BONNY DOWNS WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6572
Practice Address - Country:US
Practice Address - Phone:916-667-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246484164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse