Provider Demographics
NPI:1346640521
Name:OWUSU, EVA YAA (RN)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:YAA
Last Name:OWUSU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:YAA
Other - Last Name:OWUSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8830 E ODESSA ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-9100
Mailing Address - Country:US
Mailing Address - Phone:720-934-6368
Mailing Address - Fax:
Practice Address - Street 1:5045 S TATUM LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-0511
Practice Address - Country:US
Practice Address - Phone:303-614-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO196356163W00000X
AZ196356163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse