Healthcare Provider Details

I. General information

NPI: 1992994214
Provider Name (Legal Business Name): GENESIS OB GYN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E RIVER RD UNIT 201
TUCSON AZ
85704-5853
US

IV. Provider business mailing address

PO BOX 81064
CLEVELAND OH
44181-0064
US

V. Phone/Fax

Practice location:
  • Phone: 520-258-0585
  • Fax: 833-449-2358
Mailing address:
  • Phone: 520-795-8080
  • Fax: 520-323-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNA NELSON-MOSEKE
Title or Position: CMO
Credential: MD
Phone: 520-258-0585