Provider Demographics
NPI:1154093441
Name:OSHILAJA, LAVONDA ANNETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAVONDA
Middle Name:ANNETTE
Last Name:OSHILAJA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 E CHIPMAN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-2627
Mailing Address - Country:US
Mailing Address - Phone:602-565-6448
Mailing Address - Fax:
Practice Address - Street 1:18591 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1251
Practice Address - Country:US
Practice Address - Phone:602-789-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ252967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily