Individual provider Active NPI

Sophie Enjema Mbua Ndumbe

  • Gerontology Nurse Practitioner
  • Peoria, AZ
National Provider Identifier
1376407122
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
256331 Issued in AZ
Practice address
13451 N 94TH Dr
Peoria, AZ 85381-5056
Phone
(623) 303-7101
NPI assigned
Dec 15, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LG0600X 256331 AZ Primary

Addresses

Primary practice location

13451 N 94TH Dr
Peoria, AZ 85381-5056

Mailing address

11034 W Hadley St
Avondale, AZ 85323-4563
Phone (701) 610-8059

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
256331AZMDGerontology Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1765756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765756800000",
    "number": "1376407122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11034 W HADLEY ST",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853234563",
            "telephone_number": "701-610-8059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13451 N 94TH DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815056",
            "telephone_number": "623-303-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NDUMBE",
        "first_name": "SOPHIE ENJEMA",
        "middle_name": "MBUA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-12-15",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "256331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2025; 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.