Individual
ELI FORYANG MBEUFONJOH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
1201 S 7TH AVE, PHOENIX, AZ 85007-3913
(602) 416-7600
Mailing address
965 S WALLRADE LN, GILBERT, AZ 85296-1494
(908) 477-3144
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
R217419
MD
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
256548
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
095691
—
AZ
Enumeration date
09/02/2020
Last updated
09/06/2022
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