Charles Idemudia

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LP039775 Issued in AZ

Practice address

16088 W Soft Wind Dr
Surprise, AZ 85387-1668

Phone

(602) 327-6605

NPI assigned

Aug 25, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Supreme Healthcare LLC

  • Nursing Care Agency
  • Surprise, AZ
  • NPI 1467349704
  NPD Authorized official
• Unity Healthcare Services LLC

  • Family Nurse Practitioner
  • Sun City, AZ
  • NPI 1235707910
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1013636612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16088 W SOFT WIND DR",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853871668",
            "telephone_number": "602-327-6605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16088 W SOFT WIND DR",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853871668",
            "telephone_number": "602-327-6605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDEMUDIA",
        "first_name": "CHARLES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-25",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AZ",
            "license": "LP039775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Iannucci, C.O.T.A.
• Geoff Ross Ibe, FNP-BC
• Haifaa Ibrahim
• Safi Ibrahim
• Ideal Dental Surprise PLLC
• Ifeanyi Emmanuel Igboanugo, MPH, MSN, AGNP-C
• Ignat Ivanov Ignatov, CSA
• Ihospice Inc.
• Imperial Palace Assisted Living
• In Home Care of the Valley LLC

• Licensed Practical Nurse in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Licensed Practical Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.