Provider Demographics
NPI:1194289231
Name:NNAMANI, OLUCHI LYNDA
Entity type:Individual
Prefix:
First Name:OLUCHI
Middle Name:LYNDA
Last Name:NNAMANI
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 1:1789 7TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4341
Mailing Address - Country:US
Mailing Address - Phone:347-657-5193
Mailing Address - Fax:
Practice Address - Street 1:1789 7TH ST APT 102
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-4341
Practice Address - Country:US
Practice Address - Phone:347-657-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95146426163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3476575193Medicaid