MEDICARE: MR. GEORGE MURIITHI WANJIRU LVN

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	164X00000X	Licensed Vocational Nurse	311553	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	311553	OTHER	TX	LVM LICENSE
2	26117034	OTHER	TX	ID

General Provider Information

NPI Number	:	1932600301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE MURIITHI WANJIRU LVN

Provider Business Mailing Address
First Line	:	14100 MONTFORT DR APT 4206
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-3040
Country	:	US
Telephone Number	:	469-360-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	14100 MONTFORT DR APT 4206
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-3040
Country	:	US
Telephone Number	:	469-360-0909
Fax Number	:

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

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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