Provider Demographics
NPI:1891409231
Name:GWEBU, BLESSED
Entity Type:Individual
Prefix:
First Name:BLESSED
Middle Name:
Last Name:GWEBU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2431
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-2431
Mailing Address - Country:US
Mailing Address - Phone:707-227-8997
Mailing Address - Fax:
Practice Address - Street 1:3045 N WINSLOW ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8686
Practice Address - Country:US
Practice Address - Phone:707-227-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA772049163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health