MEDICARE: MUIRURI GEORGE WAMAE

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107085532	OTHER		MEDICAL INSURANCE

General Provider Information

NPI Number	:	1518678192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUIRURI GEORGE WAMAE

Provider Business Mailing Address
First Line	:	220 RIVERSIDE AVE UNIT 633
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-4962
Country	:	US
Telephone Number	:	404-667-3582
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 RIVERSIDE AVE UNIT 633
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-4962
Country	:	US
Telephone Number	:	404-667-3582
Fax Number	:

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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Directions to “ MUIRURI GEORGE WAMAE ” Practice Location

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