Healthcare Provider Details

I. General information

NPI: 1851967525
Provider Name (Legal Business Name): NICHOLAS GICHUKI MWANGI APN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 MOUNTAIN AVE
SPRINGFIELD NJ
07081-1755
US

IV. Provider business mailing address

52 HOY AVE
FORDS NJ
08863-1942
US

V. Phone/Fax

Practice location:
  • Phone: 973-295-6335
  • Fax:
Mailing address:
  • Phone: 732-986-7389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NJ01147600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: