Provider Demographics
NPI:1508440942
Name:ONWUZURUMBA, KIMBERLY KELECHUKWU (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KELECHUKWU
Last Name:ONWUZURUMBA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:KELECHUKWU
Other - Last Name:EVULEOCHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11120 W VAN BUREN ST APT 1145
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-7313
Mailing Address - Country:US
Mailing Address - Phone:763-843-9080
Mailing Address - Fax:
Practice Address - Street 1:9305 W THOMAS RD STE 250
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3364
Practice Address - Country:US
Practice Address - Phone:623-322-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ219520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily