Provider Demographics
NPI:1285357897
Name:WAWERU, RITAH W (NP-C)
Entity type:Individual
Prefix:
First Name:RITAH
Middle Name:W
Last Name:WAWERU
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:RITAH
Other - Middle Name:W
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-FNP-C
Mailing Address - Street 1:2420 BOSTON WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8946
Mailing Address - Country:US
Mailing Address - Phone:209-300-4039
Mailing Address - Fax:
Practice Address - Street 1:1060 DELBON AVE.
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-9538
Practice Address - Country:US
Practice Address - Phone:209-813-8913
Practice Address - Fax:209-251-0611
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022660363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily