Healthcare Provider Details

I. General information

NPI: 1841617313
Provider Name (Legal Business Name): MICHAEL MWANGI MUCHIRI NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL MWANGI NJERU MUCHIRI NP-C

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MADISON AVE SUITE 402
MANKATO MN
56001-5473
US

IV. Provider business mailing address

4131 W LOOMIS RD SUITE 300
GREENFIELD WI
53221-2057
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-7246
  • Fax: 507-386-2599
Mailing address:
  • Phone: 414-325-7246
  • Fax: 414-325-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR180854-4
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP2356
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: