Provider Demographics
NPI:1689218042
Name:AYEMOBA, PATRICIA NWAKAEGO (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:NWAKAEGO
Last Name:AYEMOBA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7862 W SALTER DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3304
Mailing Address - Country:US
Mailing Address - Phone:623-698-6071
Mailing Address - Fax:
Practice Address - Street 1:7862 W SALTER DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3304
Practice Address - Country:US
Practice Address - Phone:623-698-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ233000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily