MEDICARE: OMORUYI AYIYI FNP-C

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	363L00000X	Nurse Practitioner	12250612	AZ

General Provider Information

NPI Number	:	1881551158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMORUYI AYIYI FNP-C

Provider Business Mailing Address
First Line	:	4850 S 4TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-3180
Country	:	US
Telephone Number	:	480-286-0407
Fax Number	:

Provider Business Practice Location Address
First Line	:	4850 S 4TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-3180
Country	:	US
Telephone Number	:	480-286-0407
Fax Number	:

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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