Individual
GRACE KWAMBOKA MASIOGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5102 W CAMPBELL AVE, PHOENIX, AZ 85031-1703
(480) 344-2054
Mailing address
4633 N 111TH LN, PHOENIX, AZ 85037-8335
(623) 986-2636
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
313804
AZ
Other
Enumeration date
10/08/2024
Last updated
10/08/2024
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