Healthcare Provider Details

I. General information

NPI: 1548981376
Provider Name (Legal Business Name): VICTOR MORRISON WANGATHIKA DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 E ANGEL DR
CHANDLER AZ
85249-5707
US

IV. Provider business mailing address

482 E ANGEL DR
CHANDLER AZ
85249-5707
US

V. Phone/Fax

Practice location:
  • Phone: 480-825-5107
  • Fax:
Mailing address:
  • Phone: 480-825-5107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number259238
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: