Provider Demographics
NPI:1538771431
Name:ORNELAS, EDWARD ANTHONY (DNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:ORNELAS
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 N LOBB AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85173-2513
Mailing Address - Country:US
Mailing Address - Phone:602-999-9739
Mailing Address - Fax:
Practice Address - Street 1:96 N LOBB AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:AZ
Practice Address - Zip Code:85173-2513
Practice Address - Country:US
Practice Address - Phone:602-999-9739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032355163W00000X
AZ303766363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse