Provider Demographics
NPI:1699538660
Name:MUGOMBA, TSITSI
Entity type:Individual
Prefix:
First Name:TSITSI
Middle Name:
Last Name:MUGOMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 TULIP LN
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-8121
Mailing Address - Country:US
Mailing Address - Phone:484-524-8280
Mailing Address - Fax:
Practice Address - Street 1:197 TULIP LN
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-8121
Practice Address - Country:US
Practice Address - Phone:484-524-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN299136164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse