Healthcare Provider Details

I. General information

NPI: 1376127134
Provider Name (Legal Business Name): ANTHONY OSEAHUMEN OJEME
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12424 N 32ND ST STE 101
PHOENIX AZ
85032-7156
US

IV. Provider business mailing address

3241 E SHEA BLVD # 409
PHOENIX AZ
85028-3335
US

V. Phone/Fax

Practice location:
  • Phone: 520-484-6112
  • Fax:
Mailing address:
  • Phone: 602-492-8727
  • Fax: 329-202-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number257849
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN178098
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: