Healthcare Provider Details

I. General information

NPI: 1316420631
Provider Name (Legal Business Name): ERIC MOSOKOBE OGARI FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EUPHRASE MOSOKOBE NYOKWOYO

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16430 W YUMA RD
GOODYEAR AZ
85338-3102
US

IV. Provider business mailing address

15550 W RIO VISTA LN
GOODYEAR AZ
85338-9441
US

V. Phone/Fax

Practice location:
  • Phone: 623-465-6405
  • Fax:
Mailing address:
  • Phone: 760-521-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11535
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: