Healthcare Provider Details

I. General information

NPI: 1346572021
Provider Name (Legal Business Name): HARRIET MWANGANGYE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 CECIL MALONE DR COMMUNITY HEALTH AND HOME CARE
ITHACA NY
14850
US

IV. Provider business mailing address

108 JOANNE DR
ITHACA NY
14850-6346
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-7780
  • Fax:
Mailing address:
  • Phone: 607-262-0697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number574259-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: