Healthcare Provider Details

I. General information

NPI: 1558280875
Provider Name (Legal Business Name): ESOHE GRACE ANABA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 W 24TH ST
YUMA AZ
85364-6123
US

IV. Provider business mailing address

1150 W 24TH ST STE D
YUMA AZ
85364-8368
US

V. Phone/Fax

Practice location:
  • Phone: 928-819-8999
  • Fax:
Mailing address:
  • Phone: 928-256-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number218430
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: