Healthcare Provider Details

I. General information

NPI: 1467022004
Provider Name (Legal Business Name): LOVELINE OZIOMA IMANATUE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 W MYRTLE AVE
GLENDALE AZ
85301-8801
US

IV. Provider business mailing address

PO BOX 96770
PHOENIX AZ
85072-6770
US

V. Phone/Fax

Practice location:
  • Phone: 623-253-9829
  • Fax: 623-267-4456
Mailing address:
  • Phone: 480-660-5913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2020044450
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2020044450
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2020044450
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number257896
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: