Provider Demographics
NPI:1467901769
Name:UMAYAMMA, AMPILI (NP)
Entity Type:Individual
Prefix:
First Name:AMPILI
Middle Name:
Last Name:UMAYAMMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 S DELAWARE DR
Mailing Address - Street 2:STE 1
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-6512
Mailing Address - Country:US
Mailing Address - Phone:480-396-3222
Mailing Address - Fax:480-396-2298
Practice Address - Street 1:5252 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8022
Practice Address - Country:US
Practice Address - Phone:480-396-3222
Practice Address - Fax:480-396-2298
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP8856363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology