Healthcare Provider Details

I. General information

NPI: 1669037248
Provider Name (Legal Business Name): IVY KONADU ATTOBRA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 E SOUTHERN AVE STE 2028
MESA AZ
85206-6214
US

IV. Provider business mailing address

3707 E SOUTHERN AVE STE 2028
MESA AZ
85206-6214
US

V. Phone/Fax

Practice location:
  • Phone: 480-725-9002
  • Fax: 480-393-8540
Mailing address:
  • Phone: 480-725-9002
  • Fax: 480-393-8540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number225880
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberAP70052258
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: