Provider Demographics
NPI:1497635742
Name:UMESIRI, SUCCESS
Entity type:Individual
Prefix:MRS
First Name:SUCCESS
Middle Name:
Last Name:UMESIRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12544 W PARKWAY LN
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-4219
Mailing Address - Country:US
Mailing Address - Phone:602-837-9994
Mailing Address - Fax:
Practice Address - Street 1:12544 W PARKWAY LN
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-4219
Practice Address - Country:US
Practice Address - Phone:602-837-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ283980163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse