Healthcare Provider Details

I. General information

NPI: 1164314662
Provider Name (Legal Business Name): CONVINCE JEDDY MUTWIRI NJIRU MSN, PMHNP - BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 COBURG RD UNIT 301
EUGENE OR
97401-4900
US

IV. Provider business mailing address

1755 COBURG RD UNIT 301
EUGENE OR
97401-4900
US

V. Phone/Fax

Practice location:
  • Phone: 469-888-1971
  • Fax:
Mailing address:
  • Phone: 469-888-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10047388
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: