Doctor Name: | JENNIFER OKIDEGBE |
NPI Number: | 1285997163 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | AP4483 |
Business Practice Address: | 18545 W Sunnyslope Ln Waddell, AZ - 853554413 |
Business Phone Number: | 7634588157 |
Business Fax Number: | |
Mailing Address: | 18545 W Sunnyslope Ln, WADDELL |
State: | AZ |
Postal Code: | 853554413 |
Phone Number: | 7634588157 |
Fax Number: | |
NPI Enumeration Date: | 06/16/2012 |
NPI Last Update Date: | 06/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP4483 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |