MEDICARE: NELSA MASOG NKENDONG

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	281582	AZ

General Provider Information

NPI Number	:	1851254528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELSA MASOG NKENDONG

Provider Business Mailing Address
First Line	:	42201 N 41ST DR STE B160
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3800
Country	:	US
Telephone Number	:	480-527-0042
Fax Number	:

Provider Business Practice Location Address
First Line	:	42201 N 41ST DR STE B160
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3800
Country	:	US
Telephone Number	:	480-527-0042
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ NELSA MASOG NKENDONG ” Practice Location

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