Provider Demographics
NPI:1275214439
Name:GENESIS OF PEACE INTEGRATED HEALTH
Entity Type:Organization
Organization Name:GENESIS OF PEACE INTEGRATED HEALTH
Other - Org Name:GENESIS OF PEACE PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKOSUA
Authorized Official - Middle Name:ANKAMAH
Authorized Official - Last Name:MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:480-953-3995
Mailing Address - Street 1:11201 N TATUM BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6039
Mailing Address - Country:US
Mailing Address - Phone:480-953-3995
Mailing Address - Fax:
Practice Address - Street 1:2278 E ASTER DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2353
Practice Address - Country:US
Practice Address - Phone:480-936-3995
Practice Address - Fax:210-761-3858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty