Healthcare Provider Details

I. General information

NPI: 1053854638
Provider Name (Legal Business Name): MR. JOSIAH NNADOZIE NWAOKWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 E INDIAN SCHOOL RD STE 700
PHOENIX AZ
85014-4846
US

IV. Provider business mailing address

1095 E INDIAN SCHOOL RD STE 700
PHOENIX AZ
85014-4846
US

V. Phone/Fax

Practice location:
  • Phone: 623-225-7591
  • Fax: 623-230-3726
Mailing address:
  • Phone: 623-225-7591
  • Fax: 623-230-3726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberTAP 9692
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: