Healthcare Provider Details

I. General information

NPI: 1003225020
Provider Name (Legal Business Name): AMANI ENTERPRISES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4529 NECKER AVE
NOTTINGHAM MD
21236-2927
US

IV. Provider business mailing address

4529 NECKER AVE
NOTTINGHAM MD
21236-2927
US

V. Phone/Fax

Practice location:
  • Phone: 651-470-0357
  • Fax:
Mailing address:
  • Phone: 651-470-0357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DAVID MUNDIA MWAURA
Title or Position: CRNA
Credential:
Phone: 651-470-0357