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General NPI Number Information
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NPI Number | 1770451692
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Entity Type | Individual
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Provider Name | JOHN KWESI MENSAH
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Gender | Male
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Dates
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Enumeration Date | 10/24/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 5730 W ROOSEVELT RD
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City | CHICAGO
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State | IL
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Zip | 60644-1580
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Country | US
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Telephone | 858-774-5256
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Fax |
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Provider Business Mailing Address
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Address Line | 24050 W CHAMPION DR
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City | PLAINFIELD
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State | IL
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Zip | 60585-9581
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Country | US
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Telephone | 858-774-5256
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.033510
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License Number State | IL
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