Provider Demographics
NPI:1205530383
Name:NGUKU, ANNABEL
Entity type:Individual
Prefix:
First Name:ANNABEL
Middle Name:
Last Name:NGUKU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 WYDA WAY APT 14
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-0994
Mailing Address - Country:US
Mailing Address - Phone:707-954-9776
Mailing Address - Fax:
Practice Address - Street 1:2119 WYDA WAY APT 14
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0994
Practice Address - Country:US
Practice Address - Phone:707-954-9776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270001164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse