Healthcare Provider Details

I. General information

NPI: 1154234102
Provider Name (Legal Business Name): BONNY CHUKWUKA OGALA PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

13248 W STELLA LN
LITCHFIELD PARK AZ
85340-4093
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 206-664-1279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number223632
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: