Individual
QUEEN A IGBONAGWAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1039 E HELMICK ST, CARSON, CA 90746-3039
(310) 293-7764
(310) 632-4984
Mailing address
1039 E HELMICK ST, CARSON, CA 90746-3039
(310) 293-7764
(310) 632-4984
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
668489
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95020434
CA
Other
Enumeration date
07/18/2023
Last updated
07/18/2023
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