Healthcare Provider Details

I. General information

NPI: 1255177580
Provider Name (Legal Business Name): ANNSAGOE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16155 N 83RD AVE STE 207
PEORIA AZ
85382-5815
US

IV. Provider business mailing address

16155 N 83RD AVE STE 207
PEORIA AZ
85382-5815
US

V. Phone/Fax

Practice location:
  • Phone: 602-803-7681
  • Fax:
Mailing address:
  • Phone: 602-803-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. WILHELMINA SAGOE ANNOR
Title or Position: MEDICAL DIRECTOR
Credential: DNP
Phone: 602-803-7681