Healthcare Provider Details

I. General information

NPI: 1669238291
Provider Name (Legal Business Name): AKUEBA MINASSEH AKAKPO SITTU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E GRAND AVE STE 200
DES MOINES IA
50309-1977
US

IV. Provider business mailing address

10500 CATALINA DR
JOHNSTON IA
50131-3129
US

V. Phone/Fax

Practice location:
  • Phone: 347-891-9063
  • Fax:
Mailing address:
  • Phone: 347-891-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: AKUEBA MINASSEH AKAKPO
Title or Position: OWNER
Credential: PMHNP
Phone: 347-891-9063