Healthcare Provider Details

I. General information

NPI: 1528659299
Provider Name (Legal Business Name): OPTIMIZED WELLNESS VIRTUAL AND HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20801 N ALEXIS AVE
MARICOPA AZ
85138-6862
US

IV. Provider business mailing address

20801 N ALEXIS AVE
MARICOPA AZ
85138-6862
US

V. Phone/Fax

Practice location:
  • Phone: 623-826-4757
  • Fax:
Mailing address:
  • Phone: 623-826-4757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHARITY UKWUOMA
Title or Position: NP
Credential:
Phone: 602-767-3900