Individual
MILDRED K OMOONGEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1835 W MISSOURI AVE, PHOENIX, AZ 85015-3046
(602) 230-0777
Mailing address
2420 W BEVERLY RD, PHOENIX, AZ 85041-7625
(405) 219-5425
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
855808
TX
363LF0000X
Family Nurse Practitioner
231224
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
231224
AZ
Other
Enumeration date
04/08/2019
Last updated
08/12/2024
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