Healthcare Provider Details

I. General information

NPI: 1346640521
Provider Name (Legal Business Name): EVA YAA OWUSU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVA YAA OWUSU RN

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 11/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5045 S TATUM LN
GILBERT AZ
85298-0511
US

IV. Provider business mailing address

8830 E ODESSA ST
MESA AZ
85207-9100
US

V. Phone/Fax

Practice location:
  • Phone: 303-614-1400
  • Fax:
Mailing address:
  • Phone: 720-934-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number196356
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number196356
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: