Healthcare Provider Details

I. General information

NPI: 1417631425
Provider Name (Legal Business Name): OBIANUJU QUEEN NJOKU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 E ESTATE RD
QUEEN CREEK AZ
85140-5420
US

IV. Provider business mailing address

1073 E ESTATE RD
QUEEN CREEK AZ
85140-5420
US

V. Phone/Fax

Practice location:
  • Phone: 404-824-2475
  • Fax:
Mailing address:
  • Phone: 404-824-2475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL10279H
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: