MEDICARE: MRS. ABIODUN A OGUNDE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F02260868	AZ

General Provider Information

NPI Number	:	1407704968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ABIODUN A OGUNDE NP

Provider Business Mailing Address
First Line	:	3120 N 19TH AVE STE 170
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-6062
Country	:	US
Telephone Number	:	623-570-0234
Fax Number	:	602-279-0296

Provider Business Practice Location Address
First Line	:	3120 N 19TH AVE STE 170
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-6062
Country	:	US
Telephone Number	:	602-279-8471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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