Provider Demographics
NPI:1124710066
Name:MUGO, MICHAEL NDUATI (CRNP- PMH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NDUATI
Last Name:MUGO
Suffix:
Gender:
Credentials:CRNP- PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3884
Mailing Address - Country:US
Mailing Address - Phone:443-835-8678
Mailing Address - Fax:
Practice Address - Street 1:33455 6TH AVE S STE 2C
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6074
Practice Address - Country:US
Practice Address - Phone:253-367-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164946363LP0808X
WAAP61477252363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health