Provider Demographics
NPI:1841686623
Name:AWA, TESSY KAENA (FNP-C, MSN, RN, PHN)
Entity type:Individual
Prefix:
First Name:TESSY
Middle Name:KAENA
Last Name:AWA
Suffix:
Gender:F
Credentials:FNP-C, MSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 GREENBACK LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-6237
Mailing Address - Country:US
Mailing Address - Phone:916-745-1214
Mailing Address - Fax:
Practice Address - Street 1:6560 GREENBACK LN
Practice Address - Street 2:SUITE 200
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-6237
Practice Address - Country:US
Practice Address - Phone:916-745-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002460363LF0000X
CA844872163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse