Healthcare Provider Details

I. General information

NPI: 1750996617
Provider Name (Legal Business Name): AUDU THOMAS SERIKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2539 W SPENCER RUN
PHOENIX AZ
85041-2927
US

IV. Provider business mailing address

3554 W HIDDEN MOUNTAIN LN
PHOENIX AZ
85086-2783
US

V. Phone/Fax

Practice location:
  • Phone: 602-975-6765
  • Fax:
Mailing address:
  • Phone: 602-386-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN152606
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: