Provider Demographics
NPI:1477259810
Name:AGUWAMBA, NNEKA L (PMHNP)
Entity Type:Individual
Prefix:
First Name:NNEKA
Middle Name:L
Last Name:AGUWAMBA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 E ARABIAN DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3012
Mailing Address - Country:US
Mailing Address - Phone:973-760-2222
Mailing Address - Fax:
Practice Address - Street 1:1051 E ARABIAN DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3012
Practice Address - Country:US
Practice Address - Phone:973-760-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ287085363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health