Healthcare Provider Details

I. General information

NPI: 1184277139
Provider Name (Legal Business Name): NORBERT N MWANGI FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5099 W DOBBINS RD UNIT B
LAVEEN AZ
85339-9733
US

IV. Provider business mailing address

PO BOX 1044
LAVEEN AZ
85339-0770
US

V. Phone/Fax

Practice location:
  • Phone: 602-688-2338
  • Fax: 949-222-3462
Mailing address:
  • Phone: 602-688-2338
  • Fax: 949-222-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number233029
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number233029
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: