Healthcare Provider Details

I. General information

NPI: 1487897112
Provider Name (Legal Business Name): VERONICA WANGUI NDEGWA-GIBBONS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 DISTRIBUTION DR STE 150
SUWANEE GA
30024-4916
US

IV. Provider business mailing address

1490 DISTRIBUTION DR STE 150
SUWANEE GA
30024-4916
US

V. Phone/Fax

Practice location:
  • Phone: 678-263-3080
  • Fax: 678-496-9863
Mailing address:
  • Phone: 678-263-3080
  • Fax: 678-496-9863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN184992
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: