MEDICARE: MUINAT ADEPEJU UDOINWANG RN

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	251E00000X	Home Health Agency	HHA3362	AZ

General Provider Information

NPI Number	:	1568604445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUINAT ADEPEJU UDOINWANG RN

Provider Business Mailing Address
First Line	:	2432 W PEORIA AVE
Second Line	:	BUILDING 5 SUITE 1120
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4726
Country	:	US
Telephone Number	:	602-246-1115
Fax Number	:	602-246-1114

Provider Business Practice Location Address
First Line	:	2432 W PEORIA AVE
Second Line	:	BUILDING 5 SUITE 1120
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4726
Country	:	US
Telephone Number	:	602-246-1115
Fax Number	:	602-246-1114

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

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	03/24/2009

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