Provider Demographics
NPI:1992932081
Name:FLEMING, VIRGINIA NWANYIFE (REGISTERED NURSE)
Entity type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:NWANYIFE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16904A HALLDALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247
Mailing Address - Country:US
Mailing Address - Phone:323-385-1013
Mailing Address - Fax:310-324-4607
Practice Address - Street 1:16904A HALLDALE AVENUE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247
Practice Address - Country:US
Practice Address - Phone:323-385-1013
Practice Address - Fax:310-324-4607
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA720906163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse