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General NPI Number Information
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NPI Number | 1225317373
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Entity Type | Individual
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Provider Name | VIVIAN OWUSU-MENSAH ANP-BC AND PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 750 ROUTE 73 S STE 205
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City | MARLTON
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State | NJ
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Zip | 08053-4133
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Country | US
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Telephone | 609-584-2826
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Fax |
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Provider Business Mailing Address
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Address Line | 44 BERNARD DR
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City | EWING
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State | NJ
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Zip | 08628-2301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 30306006
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ00338800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00338800
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License Number State | NJ
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