Individual
OKEY ILOEGBUNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1510 E WAGON WHEEL LN STE 110, FORT MOHAVE, AZ 86426-6698
(928) 788-3333
(928) 788-3555
Mailing address
PO BOX 10966, FORT MOHAVE, AZ 86427-0966
(928) 788-3333
(928) 788-3555
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
AP10673
AZ
363L00000X
Nurse Practitioner
Primary
AP10673
AZ
363LF0000X
Family Nurse Practitioner
AP10673
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339857
—
AZ
Enumeration date
09/14/2017
Last updated
03/17/2018
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