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NPI Code Detail

MEDICARE: MILDRED K OMOONGEH NP

MEDICARE: MILDRED K OMOONGEH 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
1163WC0200XCritical Care Medicine Registered Nurse855808TX
2363LF0000XFamily Nurse Practitioner231224AZ
3363LP0808XPsychiatric/Mental Health Nurse Practitioner231224AZ

General Provider Information

NPI Number : 1760945752
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILDRED K OMOONGEH NP
Provider Business Mailing Address
First Line : 2420 W BEVERLY RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85041-7625
Country : US
Telephone Number : 405-219-5425
Fax Number :
Provider Business Practice Location Address
First Line : 1835 W MISSOURI AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-3046
Country : US
Telephone Number : 602-230-0777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2019
Last Update Date : 08/12/2024

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