Prisca Ajonghage
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Surprise, AZ
NPI 1831783679 · NPPES record last updated Feb 23, 2021
Key facts
- NPI
- 1831783679
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 254054 (AZ)
- Practice address
- 17470 W Ventura St
Surprise, AZ 85388-7806 - Phone
- (408) 597-5067
- NPI assigned
- Feb 23, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Interoperability endpoints
- pajonghage@destiny-springs-hc.direct.kno2fy.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 254054 | AZ | Yes |
Addresses
Primary practice location
17470 W Ventura St
Surprise, AZ 85388-7806
Mailing address
17470 W Ventura St
Surprise, AZ 85388-7806
Other providers in Surprise, AZ
- Pamela Bunnell Ahlmer
- Huda N Ahmed
- Ahwatukee Health Care, LLC
- Jeffrey M Ainsa
- Nader R. Ajluni
- Folake Akanbi
- Akobuwet Psychiatry PLLC
- Ahmed Al Ezzi
- Alphonse Alapat
- Gabriel Alarcon
All providers in Surprise, AZ · Psychiatric/Mental Health Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.