Healthcare Provider Details

I. General information

NPI: 1356263164
Provider Name (Legal Business Name): BETH MWANGI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 BODWELL AVE
LOWELL MA
01854-2403
US

IV. Provider business mailing address

18 BODWELL AVE
LOWELL MA
01854-2403
US

V. Phone/Fax

Practice location:
  • Phone: 978-427-1319
  • Fax:
Mailing address:
  • Phone: 978-427-1319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC2300X
TaxonomyChronic Care Clinical Nurse Specialist
License NumberLN63450
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: