Healthcare Provider Details

I. General information

NPI: 1760132369
Provider Name (Legal Business Name): GEORGE OSEKO NYAKUNDI MSN,PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 N SUNSET BLVD STE 320
GLENDALE AZ
85305-3155
US

IV. Provider business mailing address

6751 N SUNSET BLVD STE 320
GLENDALE AZ
85305-3155
US

V. Phone/Fax

Practice location:
  • Phone: 480-564-3753
  • Fax: 480-597-1297
Mailing address:
  • Phone: 480-564-3753
  • Fax: 480-597-1297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number293328
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number81079
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: