Provider Demographics
NPI:1851188239
Name:NAKONECHNA, NADIIA
Entity type:Individual
Prefix:
First Name:NADIIA
Middle Name:
Last Name:NAKONECHNA
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 1:1900 BLUE OAKS BLVD APT 1438
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-8451
Mailing Address - Country:US
Mailing Address - Phone:916-903-9530
Mailing Address - Fax:
Practice Address - Street 1:1900 BLUE OAKS BLVD APT 1438
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-8451
Practice Address - Country:US
Practice Address - Phone:916-903-9530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker