Provider Demographics
NPI:1053854638
Name:NWAOKWA, JOSIAH NNADOZIE
Entity Type:Individual
Prefix:MR
First Name:JOSIAH
Middle Name:NNADOZIE
Last Name:NWAOKWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 E INDIAN SCHOOL RD STE 700
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4846
Mailing Address - Country:US
Mailing Address - Phone:623-225-7591
Mailing Address - Fax:623-230-3726
Practice Address - Street 1:1095 E INDIAN SCHOOL RD STE 700
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4846
Practice Address - Country:US
Practice Address - Phone:623-225-7591
Practice Address - Fax:623-230-3726
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP 9692363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ223013Medicaid