Healthcare Provider Details

I. General information

NPI: 1851254528
Provider Name (Legal Business Name): NELSA MASOG NKENDONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42201 N 41ST DR STE B160
ANTHEM AZ
85086-3800
US

IV. Provider business mailing address

42201 N 41ST DR STE B160
ANTHEM AZ
85086-3800
US

V. Phone/Fax

Practice location:
  • Phone: 480-527-0042
  • Fax:
Mailing address:
  • Phone: 480-527-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number281582
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: