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General NPI Number Information
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NPI Number | 1245638048
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Entity Type | Individual
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Provider Name | JOHN KAMAU NGUGI CRNP-BC
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Gender | Male
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 1314 BEDFORD AVE STE 113
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City | PIKESVILLE
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State | MD
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Zip | 21208-3737
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Country | US
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Telephone | 480-877-8780
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Fax | 443-732-0054
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Provider Business Mailing Address
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Address Line | PO BOX 72098
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City | ROSEDALE
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State | MD
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Zip | 21237-8098
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Country | US
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Telephone | 480-878-7806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R179125
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License Number State | MD
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