Provider Demographics
NPI:1992140248
Name:MAVUNGA, SPIWE N/A (LPN)
Entity type:Individual
Prefix:MRS
First Name:SPIWE
Middle Name:N/A
Last Name:MAVUNGA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4478 CHESWICK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6004
Mailing Address - Country:US
Mailing Address - Phone:614-470-9612
Mailing Address - Fax:
Practice Address - Street 1:4478 CHESWICK RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-6004
Practice Address - Country:US
Practice Address - Phone:614-470-9612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139355164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse