MEDICARE: OSAGINWEN KINGSLEY AYIYI NP-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	363LF0000X	Family Nurse Practitioner	AP8375	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871959965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSAGINWEN KINGSLEY AYIYI NP-C

Provider Business Mailing Address
First Line	:	3301 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7302
Country	:	US
Telephone Number	:	602-899-7774
Fax Number	:	602-899-7877

Provider Business Practice Location Address
First Line	:	3301 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7302
Country	:	US
Telephone Number	:	602-899-7774
Fax Number	:	602-899-7877

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

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	06/16/2018

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