Healthcare Provider Details

I. General information

NPI: 1265154371
Provider Name (Legal Business Name): MARTHA MWALE MULENGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 W ALAMEDA AVE
LAKEWOOD CO
80226-2908
US

IV. Provider business mailing address

11 E ORANGE GROVE RD APT 1723
TUCSON AZ
85704-5525
US

V. Phone/Fax

Practice location:
  • Phone: 720-547-9162
  • Fax:
Mailing address:
  • Phone: 856-885-3059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP280586
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: