Healthcare Provider Details

I. General information

NPI: 1427828854
Provider Name (Legal Business Name): BANCY MWANGI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53779 GENERATIONS DR STE D
SOUTH BEND IN
46635-1577
US

IV. Provider business mailing address

53779 GENERATIONS DR STE D
SOUTH BEND IN
46635-1577
US

V. Phone/Fax

Practice location:
  • Phone: 574-383-8072
  • Fax:
Mailing address:
  • Phone: 574-383-8072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023151887
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: