Healthcare Provider Details

I. General information

NPI: 1659110252
Provider Name (Legal Business Name): HENRY ASONGWE MUMA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 GOLDEN EAGLE CT NE APT D306
RIO RANCHO NM
87144-7034
US

IV. Provider business mailing address

4311 GOLDEN EAGLE CT NE
RIO RANCHO NM
87144-7034
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-4296
  • Fax:
Mailing address:
  • Phone: 505-310-4296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14594
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number79126
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: