Healthcare Provider Details

I. General information

NPI: 1942864095
Provider Name (Legal Business Name): ANNE MUTHONI MOKONYAMA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNE MUTHONI WAITHERA

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NUTT RD
PHOENIXVILLE PA
19460-3900
US

IV. Provider business mailing address

140 NUTT RD
PHOENIXVILLE PA
19460-3900
US

V. Phone/Fax

Practice location:
  • Phone: 610-983-1601
  • Fax:
Mailing address:
  • Phone: 610-983-1601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019868
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: