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General NPI Number Information
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NPI Number | 1427828854
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Entity Type | Individual
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Provider Name | BANCY MWANGI FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/05/2024
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 3809 N MAIN ST STE 100
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City | MISHAWAKA
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State | IN
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Zip | 46545-3109
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Country | US
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Telephone | 574-520-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 50515 MERCURY DR
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City | GRANGER
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State | IN
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Zip | 46530-8501
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Country | US
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Telephone | 574-216-0874
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2023151887
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License Number State | IN
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