MEDICARE: ALYS OXENTENKO NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP7387	AZ

General Provider Information

NPI Number	:	1750785168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYS OXENTENKO NP

Provider Business Mailing Address
First Line	:	2042 N 35TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-2353
Country	:	US
Telephone Number	:	602-527-1052
Fax Number	:

Provider Business Practice Location Address
First Line	:	2042 N 35TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-2353
Country	:	US
Telephone Number	:	602-527-1052
Fax Number	:

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

Provider Enumeration Date	:	10/14/2014
Last Update Date	:	10/04/2023

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Directions to “ ALYS OXENTENKO NP” Practice Location

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