Healthcare Provider Details

I. General information

NPI: 1568043990
Provider Name (Legal Business Name): ANNA NALUKWAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 04/17/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 W GREENTREE DR STE 103
TEMPE AZ
85284-2712
US

IV. Provider business mailing address

3208 RAVENWOOD ST
ANN ARBOR MI
48103-2658
US

V. Phone/Fax

Practice location:
  • Phone: 602-666-5101
  • Fax:
Mailing address:
  • Phone: 734-276-4539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: