Provider Demographics
NPI:1720801947
Name:WANGOMBE, MARGARET MUMBI
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MUMBI
Last Name:WANGOMBE
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 1:6151 STRAWBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1790
Mailing Address - Country:US
Mailing Address - Phone:443-493-3209
Mailing Address - Fax:
Practice Address - Street 1:105 TIME SQ
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2808
Practice Address - Country:US
Practice Address - Phone:443-493-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily