Healthcare Provider Details

I. General information

NPI: 1912508698
Provider Name (Legal Business Name): JUDITH OSUAGWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2020
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85395-2635
US

IV. Provider business mailing address

13677 W MCDOWELL RD
GOODYEAR AZ
85395-2635
US

V. Phone/Fax

Practice location:
  • Phone: 623-806-2965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRNP336568
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: