MEDICARE: MR. CHARLES A MUGISHA RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	138020-030	WI
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	138020-030	WI
3	163WP0808X	Psychiatric/Mental Health Registered Nurse	750029	TX
4	163WH0200X	Home Health Registered Nurse	750029	TX

General Provider Information

NPI Number	:	1265585616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES A MUGISHA RN

Provider Business Mailing Address
First Line	:	5120 LEERAY ROAD
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248
Country	:	US
Telephone Number	:	181-738-0173
Fax Number	:

Provider Business Practice Location Address
First Line	:	5120 LEERAY ROAD
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248
Country	:	US
Telephone Number	:	181-738-0173
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	03/01/2009

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Directions to “ MR. CHARLES A MUGISHA RN” Practice Location

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