MEDICARE: JOYCE M MWANGI

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	163W00000X	Registered Nurse	598658-1	NY
2	363LF0000X	Family Nurse Practitioner	F343431-1	NY

General Provider Information

NPI Number	:	1992276174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE M MWANGI

Provider Business Mailing Address
First Line	:	2233 ESPLANADE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5405
Country	:	US
Telephone Number	:	718-918-1100
Fax Number	:	718-918-1100

Provider Business Practice Location Address
First Line	:	2233 ESPLANADE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5405
Country	:	US
Telephone Number	:	718-918-1100
Fax Number	:	718-918-1106

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

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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