Provider Demographics
NPI:1720766850
Name:ONOJA, MACBETH EMMANUEL (FNP)
Entity Type:Individual
Prefix:
First Name:MACBETH
Middle Name:EMMANUEL
Last Name:ONOJA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 W LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2479
Mailing Address - Country:US
Mailing Address - Phone:623-755-4410
Mailing Address - Fax:
Practice Address - Street 1:5135 W LYDIA LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2479
Practice Address - Country:US
Practice Address - Phone:623-755-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ294320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily