Provider Demographics
NPI:1336843614
Name:NYAGAH, JOHN MAINA (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MAINA
Last Name:NYAGAH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LONG WARF PL
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2615
Mailing Address - Country:US
Mailing Address - Phone:302-563-6900
Mailing Address - Fax:
Practice Address - Street 1:14 LONG WARF PL
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-2615
Practice Address - Country:US
Practice Address - Phone:302-563-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA722685163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator