Healthcare Provider Details

I. General information

NPI: 1275214439
Provider Name (Legal Business Name): GENESIS OF PEACE INTEGRATED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 S VAL VISTA DR STE A111
GILBERT AZ
85297-7319
US

IV. Provider business mailing address

2278 E ASTER DR
CHANDLER AZ
85286-2353
US

V. Phone/Fax

Practice location:
  • Phone: 480-936-3995
  • Fax: 210-761-3858
Mailing address:
  • Phone: 480-953-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. AKOSUA ANKAMAH MENSAH
Title or Position: OWNER/NURSE PRACTITIONER
Credential: DNP, FNP-C
Phone: 480-953-3995