Provider Demographics
NPI:1730807124
Name:FRIMPONG, MAVIS TABI (ARNP)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:TABI
Last Name:FRIMPONG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-6049
Mailing Address - Country:US
Mailing Address - Phone:405-881-2654
Mailing Address - Fax:
Practice Address - Street 1:815 HIGH RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:IA
Practice Address - Zip Code:50211-1462
Practice Address - Country:US
Practice Address - Phone:515-981-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH17056363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health