Basic Information
| Provider Information | |||||||||
| NPI: | 1982246484 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OWUSU-ANSAH | ||||||||
| FirstName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5531 CANYON RD APT 728 | ||||||||
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| City: | BENBROOK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761261813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174495235 | ||||||||
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| Practice Location | |||||||||
| Address1: | 358 E JAVELINA AVE | ||||||||
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| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852106205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808317563 | ||||||||
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| ProviderEnumerationDate: | 10/16/2019 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 233236 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.