Healthcare Provider Details

I. General information

NPI: 1114533130
Provider Name (Legal Business Name): OLUFUNKE JINADU PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14040 N CAVE CREEK RD STE 205
PHOENIX AZ
85022-6179
US

IV. Provider business mailing address

1301 E DEBBIE LN
MANSFIELD TX
76063-3305
US

V. Phone/Fax

Practice location:
  • Phone: 602-358-7073
  • Fax: 888-927-0409
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number278657
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number61359831
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1079593
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number843718
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: