Provider Demographics
NPI:1588322424
Name:MWANGI, JOEL NGOTHO
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:NGOTHO
Last Name:MWANGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 DINGWELL ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1542
Mailing Address - Country:US
Mailing Address - Phone:978-677-1079
Mailing Address - Fax:
Practice Address - Street 1:45 DINGWELL ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1542
Practice Address - Country:US
Practice Address - Phone:978-677-1079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN88273164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse