Healthcare Provider Details

I. General information

NPI: 1255045993
Provider Name (Legal Business Name): VIENNA MUENI MUNGUTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30067 W 184TH TER
GARDNER KS
66030-8803
US

IV. Provider business mailing address

30067 W 184TH TER
GARDNER KS
66030-8803
US

V. Phone/Fax

Practice location:
  • Phone: 816-878-8773
  • Fax:
Mailing address:
  • Phone: 816-878-8773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-81363-032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: