Provider Demographics
NPI:1861149296
Name:ULTIMATE PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:ULTIMATE PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:ANNABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-804-0866
Mailing Address - Street 1:22498 E TWIN ACRES DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-0609
Mailing Address - Country:US
Mailing Address - Phone:614-804-0866
Mailing Address - Fax:
Practice Address - Street 1:216 COMMERCIAL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3410
Practice Address - Country:US
Practice Address - Phone:614-804-0866
Practice Address - Fax:253-954-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-05
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty