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General NPI Number Information
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NPI Number | 1336815562
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Entity Type | Individual
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Provider Name | ALEXANDRIA W. MWANGA DNP, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 2321 E GALA ST STE 3
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City | MERIDIAN
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State | ID
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Zip | 83642-7692
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Country | US
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Telephone | 208-888-5848
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Fax | 208-888-0884
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Provider Business Mailing Address
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Address Line | 1965 S EAGLE RD STE 180
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City | MERIDIAN
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State | ID
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Zip | 83642-9246
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Country | US
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Telephone | 986-666-3866
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Fax | 986-666-3038
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | 69372
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 69372
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 69372
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 69372
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 69372
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License Number State | ID
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