Healthcare Provider Details

I. General information

NPI: 1336683440
Provider Name (Legal Business Name): GOSTINE DANKWA PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E RAY RD STE 130
GILBERT AZ
85296-4206
US

IV. Provider business mailing address

14135 SUNDIAL STONE LN
CYPRESS TX
77429-1100
US

V. Phone/Fax

Practice location:
  • Phone: 832-819-4378
  • Fax: 253-954-3116
Mailing address:
  • Phone: 614-804-0635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number10002296RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60808469
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP132780
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10002296APRN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: