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NPI Code Detail

MEDICARE: JEANNE MUTONGERWA

MEDICARE: JEANNE MUTONGERWA
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
1164X00000XLicensed Vocational NurseVN205543CA
2163WH0200XHome Health Registered Nurse838925NV

General Provider Information

NPI Number : 1477008001
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNE MUTONGERWA
Provider Business Mailing Address
First Line : 4040 S EASTERN AVE STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0854
Country : US
Telephone Number : 702-463-0300
Fax Number :
Provider Business Practice Location Address
First Line : 4040 S EASTERN AVE STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0854
Country : US
Telephone Number : 702-463-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2016
Last Update Date : 01/05/2024

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Directions to “ JEANNE MUTONGERWA ” Practice Location

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