Nicole Elizabeth Zack Nwobodo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5740 Issued in AZ

Practice address

5605 W Eugie Ave
Ste. 200
Glendale, AZ 85304-1272

Phone

(602) 843-2991

Fax

(602) 978-1226

NPI assigned

Mar 3, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Arizona Asthma Allergy Legacy PLC

  • Allergy & Immunology Physician
  • Peoria, AZ
  • NPI 1922762699

  Physician Assistant

  NPD (past)
• One Stop Medical Center

  • Clinic/Center
  • Casselberry, FL
  • NPI 1336335066
  NPD (past)
• Rockford Health Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  NPD (past)

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

{
    "created_epoch": "1267574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508112000000",
    "number": "1619290822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13965 N 75TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853816097",
            "telephone_number": "602-843-2991",
            "fax_number": "602-978-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5605 W EUGIE AVE",
            "address_2": "STE. 200",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853041272",
            "telephone_number": "602-843-2991",
            "fax_number": "602-978-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NWOBODO",
        "first_name": "NICOLE",
        "middle_name": "ELIZABETH ZACK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-03",
        "last_updated": "2017-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5740",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10711",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roberto Nunez-Villarreal
• Debbie Nina Nunley
• Nuvision Centers , PLLC
• Chinenye Nwafor, LPN
• Uche Nwambuonwo, PT, DPT
• Kerubo Happiness Nyachieo, PMHNP
• George Oseko Nyakundi, MSN,PMHNP-BC
• Dan Nydegger, D.D.S.
• Deric H Nye, D.O.
• Elisabetta G Nyholm-Jensen, D.C.

• Physician Assistant in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2017; 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.