MEDICARE: COMFORT N. UBADIGBO FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	283052	AZ
2	363LF0000X	Family Nurse Practitioner	283052	AZ

General Provider Information

NPI Number	:	1104543669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COMFORT N. UBADIGBO FNP-C

Provider Business Mailing Address
First Line	:	261 N ROOSEVELT AVE
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2617
Country	:	US
Telephone Number	:	480-677-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	10410 N 35TH AVE STE 112-114
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-1303
Country	:	US
Telephone Number	:	480-677-8282
Fax Number	:	480-535-0962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	07/19/2024

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