Provider Demographics
NPI:1841091352
Name:NYAGAH, EDWARD
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:NYAGAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 W QUEENS WAY
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-9176
Mailing Address - Country:US
Mailing Address - Phone:559-644-2330
Mailing Address - Fax:
Practice Address - Street 1:2044 W QUEENS WAY
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-9176
Practice Address - Country:US
Practice Address - Phone:559-644-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA748044164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse