Provider Demographics
NPI:1962109785
Name:NGARUIYA, ANNE N
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:N
Last Name:NGARUIYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28581 N CLOVER CIR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5869
Mailing Address - Country:US
Mailing Address - Phone:316-616-7528
Mailing Address - Fax:
Practice Address - Street 1:1350 E MCKELLIPS RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2739
Practice Address - Country:US
Practice Address - Phone:480-608-4877
Practice Address - Fax:480-608-4878
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ281557363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health