Provider Demographics
NPI:1982326906
Name:MWANGI, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
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 1:17400 17TH PL NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5202
Mailing Address - Country:US
Mailing Address - Phone:302-357-5104
Mailing Address - Fax:425-200-6172
Practice Address - Street 1:17400 17TH PL NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5202
Practice Address - Country:US
Practice Address - Phone:302-357-5104
Practice Address - Fax:425-200-6172
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA753455374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide