Provider Demographics
NPI:1699319103
Name:ANYAKPOR, NATHALIE (MSN RN FNP-C)
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:ANYAKPOR
Suffix:
Gender:F
Credentials:MSN RN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13409 S WILKIE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-1540
Mailing Address - Country:US
Mailing Address - Phone:310-710-6612
Mailing Address - Fax:
Practice Address - Street 1:500 W 190TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4268
Practice Address - Country:US
Practice Address - Phone:714-452-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine