Provider Demographics
NPI:1043832603
Name:MENSAH, GENEVIEVE NANA (NP)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:NANA
Last Name:MENSAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 E KINGSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-7517
Mailing Address - Country:US
Mailing Address - Phone:718-295-8243
Mailing Address - Fax:
Practice Address - Street 1:58 E KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-7517
Practice Address - Country:US
Practice Address - Phone:718-295-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345404-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF34540401OtherF34540401
NYF345404-01Medicaid