Healthcare Provider Details

I. General information

NPI: 1881434066
Provider Name (Legal Business Name): ONYINYECHUKWU CRYSTAL OKAFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13794 W WADDELL RD # 203-152
SURPRISE AZ
85379-8499
US

IV. Provider business mailing address

13794 W WADDELL RD # 203-152
SURPRISE AZ
85379-8499
US

V. Phone/Fax

Practice location:
  • Phone: 602-777-2194
  • Fax:
Mailing address:
  • Phone: 602-777-2194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number304285
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: