Healthcare Provider Details

I. General information

NPI: 1255008876
Provider Name (Legal Business Name): ROSEMARY WANGARI MUKIRA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 YORK RD
BALTIMORE MD
21212-2152
US

IV. Provider business mailing address

4910 GILRAY DR
BALTIMORE MD
21214-2134
US

V. Phone/Fax

Practice location:
  • Phone: 410-718-2065
  • Fax:
Mailing address:
  • Phone: 410-718-2065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR197124
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberR197124
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: