Healthcare Provider Details

I. General information

NPI: 1225510001
Provider Name (Legal Business Name): REUEL KAGAMBA MUIRURI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 12TH AVE
GRAFTON WI
53024-1923
US

IV. Provider business mailing address

1220 DEWEY AVE
WAUWATOSA WI
53213-2504
US

V. Phone/Fax

Practice location:
  • Phone: 833-711-1970
  • Fax:
Mailing address:
  • Phone: 414-773-4312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8635-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8635-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: