Emmanuel Oluwadare

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN-RNP257887 Issued in AZ

Practice address

15640 N 7TH St Ste A1
Phoenix, AZ 85022-3520

Phone

(602) 858-0191

NPI assigned

May 21, 2025

Last updated

May 21, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sanctuary Treatment Center PLLCGroup PAC ID 5496298697, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Dare Behavioral Health and Wellness Clinic PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesa, AZ
  • NPI 1467341883
  Medicare reassignment NPD Authorized official
• Sanctuary Treatment Center PLLC

  • Psychiatry Physician
  • Scottsdale, AZ
  • NPI 1558087916
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1747785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1902698277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5235 E SOUTHERN AVE STE 106-145",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063626",
            "telephone_number": "480-501-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15640 N 7TH ST STE A1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850223520",
            "telephone_number": "602-858-0191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLUWADARE",
        "first_name": "EMMANUEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-05-21",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "APRN-RNP257887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby Olson, DDS
• Kassidy Olsson
• Simon Olstein, MD
• Brooke Ashley Oltsik
• Keauna Olugu, D.O. PH.D
• Funmilayo Oluwole, FNP-BC/PMHNP-BC
• Jacqueline Barrera Olvera, NP
• Olympic Physical Therapy, Inc (Physicians Physical Therapy Service)
• Kimhiek Om, PHARMD
• Nathaniel Oman, PHARMD

• Psychiatric/Mental Health Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.