MEDICARE: MRS. IVY KONADU ATTOBRA PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	225880	AZ
2	2084P0800X	Psychiatry Physician	AP70052258	WA

General Provider Information

NPI Number	:	1669037248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IVY KONADU ATTOBRA PMHNP-BC

Provider Business Mailing Address
First Line	:	3707 E SOUTHERN AVE STE 2028
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-6214
Country	:	US
Telephone Number	:	480-725-9002
Fax Number	:	480-393-8540

Provider Business Practice Location Address
First Line	:	3707 E SOUTHERN AVE STE 2028
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-6214
Country	:	US
Telephone Number	:	480-725-9002
Fax Number	:	480-393-8540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2019
Last Update Date	:	12/26/2025

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