Provider Demographics
NPI:1295418028
Name:YEBUAH, WILBUR N (RN)
Entity type:Individual
Prefix:
First Name:WILBUR
Middle Name:N
Last Name:YEBUAH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:WIL
Other - Middle Name:
Other - Last Name:YEBUAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4626 N 16TH ST APT 1418
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5151
Mailing Address - Country:US
Mailing Address - Phone:615-516-1079
Mailing Address - Fax:
Practice Address - Street 1:2302 N CENTRAL AVE STE 7
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1332
Practice Address - Country:US
Practice Address - Phone:602-313-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000246087163W00000X
AZI026887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No163W00000XNursing Service ProvidersRegistered Nurse