Healthcare Provider Details

I. General information

NPI: 1578296984
Provider Name (Legal Business Name): JACQUELINE W MWANGI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2022
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BECKS WOODS DR STE 200
BEAR DE
19701-3852
US

IV. Provider business mailing address

5 BROOKLAND AVE
WILMINGTON DE
19805-1109
US

V. Phone/Fax

Practice location:
  • Phone: 302-834-7676
  • Fax:
Mailing address:
  • Phone: 434-227-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0044515
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC004595
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0012090
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: