Healthcare Provider Details

I. General information

NPI: 1720726524
Provider Name (Legal Business Name): ORIENA TEIBA MENSAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date: 02/20/2023
Reactivation Date: 03/01/2023

III. Provider practice location address

530 NE GLEN OAK
PEORIA IL
61637
US

IV. Provider business mailing address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-4163
  • Fax:
Mailing address:
  • Phone: 309-655-4163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2026-01117
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: