Provider Demographics
NPI:1376127134
Name:OJEME, ANTHONY OSEAHUMEN
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:OSEAHUMEN
Last Name:OJEME
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 1:915 N 52ND ST APT 2020
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7934
Mailing Address - Country:US
Mailing Address - Phone:520-484-6112
Mailing Address - Fax:
Practice Address - Street 1:12424 N 32ND ST STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7156
Practice Address - Country:US
Practice Address - Phone:520-484-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN178098163WP0808X
AZ257849363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health