Provider Demographics
NPI:1487289195
Name:ONSITE PRIMARY CARE AND NURSING
Entity type:Organization
Organization Name:ONSITE PRIMARY CARE AND NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DESALEGN
Authorized Official - Middle Name:
Authorized Official - Last Name:EJIGU
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:408-387-3269
Mailing Address - Street 1:5665 AMNEST WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1928
Mailing Address - Country:US
Mailing Address - Phone:408-387-3269
Mailing Address - Fax:
Practice Address - Street 1:678 3RD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-4034
Practice Address - Country:US
Practice Address - Phone:408-387-3269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care