Provider Demographics
NPI:1033702519
Name:FIDEL PSYCHIATRIC HEALTH SERVICES
Entity Type:Organization
Organization Name:FIDEL PSYCHIATRIC HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FIDELIS
Authorized Official - Middle Name:OSONDU
Authorized Official - Last Name:EBEREONWU
Authorized Official - Suffix:
Authorized Official - Credentials:MSN PMHNP-BC
Authorized Official - Phone:480-332-8764
Mailing Address - Street 1:924 W JESSICA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-3978
Mailing Address - Country:US
Mailing Address - Phone:480-332-8764
Mailing Address - Fax:602-323-1769
Practice Address - Street 1:924 W JESSICA LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-3978
Practice Address - Country:US
Practice Address - Phone:480-332-8764
Practice Address - Fax:602-323-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty