1861235400 NPI number — MAVIS OWUSU RN,MSN, APRN,FNP-BC

Table of content: MAVIS OWUSU RN,MSN, APRN,FNP-BC (NPI 1861235400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861235400 NPI number — MAVIS OWUSU RN,MSN, APRN,FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWUSU
Provider First Name:
MAVIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN,MSN, APRN,FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GYAU-ANING
Provider Other First Name:
MAVIS
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSC.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861235400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35380
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89133-5380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-463-5600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1421 S POTOMAC ST STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80012-4512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-894-7800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APN.0999835-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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