Provider Demographics
NPI:1750759395
Name:OMONDI, CAREN ADHIAMBO (PMHNP, FNP)
Entity type:Individual
Prefix:MRS
First Name:CAREN
Middle Name:ADHIAMBO
Last Name:OMONDI
Suffix:
Gender:F
Credentials:PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13540 W CAMINO DEL SOL
Mailing Address - Street 2:STE 3
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4435
Mailing Address - Country:US
Mailing Address - Phone:602-693-6963
Mailing Address - Fax:844-628-1655
Practice Address - Street 1:13540 W CAMINO DEL SOL
Practice Address - Street 2:STE 3
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4435
Practice Address - Country:US
Practice Address - Phone:602-693-6963
Practice Address - Fax:844-628-1655
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8487363LF0000X, 363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1139936Medicaid
AZ160368Medicaid
AZZ201246OtherMEDICARE