Healthcare Provider Details

I. General information

NPI: 1437862257
Provider Name (Legal Business Name): PETER NJOGU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28581 N CLOVER CIR
SAN TAN VALLEY AZ
85143-5869
US

IV. Provider business mailing address

1350 E MCKELLIPS RD STE 2
MESA AZ
85203-2739
US

V. Phone/Fax

Practice location:
  • Phone: 316-371-9196
  • Fax:
Mailing address:
  • Phone: 316-371-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number279774
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: