Healthcare Provider Details

I. General information

NPI: 1528433307
Provider Name (Legal Business Name): HAWA MBICHENYI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2015
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 SE MASON LN
WAUKEE IA
50263-1277
US

IV. Provider business mailing address

1305 SE MASON LN
WAUKEE IA
50263-1277
US

V. Phone/Fax

Practice location:
  • Phone: 240-639-3024
  • Fax:
Mailing address:
  • Phone: 240-639-3024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG191727
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: