Healthcare Provider Details

I. General information

NPI: 1417727496
Provider Name (Legal Business Name): GIVEN M MWIMBE AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SAINT JOSEPH TER
WOODBRIDGE NJ
07095-2614
US

IV. Provider business mailing address

3 SAINT JOSEPH TER
WOODBRIDGE NJ
07095-2614
US

V. Phone/Fax

Practice location:
  • Phone: 732-841-0162
  • Fax: 732-634-1811
Mailing address:
  • Phone: 732-841-0162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number26NJ14981000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: