Provider Demographics
NPI:1699590562
Name:MWANGI, ELIZABETH W
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:W
Last Name:MWANGI
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 1:17668 130TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9820
Mailing Address - Country:US
Mailing Address - Phone:732-527-2266
Mailing Address - Fax:
Practice Address - Street 1:12121 130TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-4443
Practice Address - Country:US
Practice Address - Phone:732-527-2266
Practice Address - Fax:253-693-9963
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61251580163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse