Healthcare Provider Details

I. General information

NPI: 1083978274
Provider Name (Legal Business Name): CHISOMNAZU WINIFRED IWEHA-ONONYE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 WEST THOMAS ROAD
PHOENIX AZ
85033
US

IV. Provider business mailing address

2702 NORTH 3RD STREET 4020
PHOENIX AZ
85004
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 623-247-9742
Mailing address:
  • Phone: 602-323-3407
  • Fax: 602-323-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4314
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: