Provider Demographics
NPI:1700455169
Name:MGBARA, ANTHONIA N
Entity Type:Individual
Prefix:MRS
First Name:ANTHONIA
Middle Name:N
Last Name:MGBARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 W GREENWAY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-3474
Mailing Address - Country:US
Mailing Address - Phone:623-251-8066
Mailing Address - Fax:602-942-4993
Practice Address - Street 1:1849 W GREENWAY RD STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-3474
Practice Address - Country:US
Practice Address - Phone:623-251-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist