Provider Demographics
NPI:1255700506
Name:NDEMANU, JANE-FRANCES (FNP)
Entity type:Individual
Prefix:
First Name:JANE-FRANCES
Middle Name:
Last Name:NDEMANU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JANE-FRANCES
Other - Middle Name:
Other - Last Name:NDEMANU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:18168 W WIND SONG AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-5063
Mailing Address - Country:US
Mailing Address - Phone:602-614-8601
Mailing Address - Fax:
Practice Address - Street 1:18168 W WIND SONG AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-5063
Practice Address - Country:US
Practice Address - Phone:602-614-8601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8155363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTAP8155Medicaid
AZTAP8155Medicaid
AZTAP8155Medicare PIN