Healthcare Provider Details

I. General information

NPI: 1659613487
Provider Name (Legal Business Name): JOHN W NJOROGE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 W MCDOWELL RD
AVONDALE AZ
85392-4864
US

IV. Provider business mailing address

10550 W MCDOWELL RD
AVONDALE AZ
85392-4864
US

V. Phone/Fax

Practice location:
  • Phone: 480-565-3035
  • Fax:
Mailing address:
  • Phone: 480-565-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number297082
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: