Provider Demographics
NPI:1255532149
Name:AMACHI, NNENNA (NP)
Entity type:Individual
Prefix:
First Name:NNENNA
Middle Name:
Last Name:AMACHI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12377 LEWIS ST STE 105
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4691
Mailing Address - Country:US
Mailing Address - Phone:714-823-4780
Mailing Address - Fax:
Practice Address - Street 1:12377 LEWIS ST STE 105
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4691
Practice Address - Country:US
Practice Address - Phone:714-823-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P97613Medicare UPIN