Healthcare Provider Details

I. General information

NPI: 1083074306
Provider Name (Legal Business Name): ELLEN MUSAKWA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 N CENTRAL AVE BLDG C
PHOENIX AZ
85012-3313
US

IV. Provider business mailing address

3971 E CONSTITUTION DR
GILBERT AZ
85296-0945
US

V. Phone/Fax

Practice location:
  • Phone: 602-679-5262
  • Fax:
Mailing address:
  • Phone: 951-966-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10422
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: