=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427971001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MILTONE MAWALA NYAMBU
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2026
-----------------------------------------------------
Last Update Date | 07/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 W FRIENDLY AVE STE 100A
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-6130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-938-0077
-----------------------------------------------------
Fax | 336-232-1516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1112 DARTMOUTH DR
-----------------------------------------------------
City | MEBANE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27302-7838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-938-0077
-----------------------------------------------------
Fax | 336-232-1516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 5025093
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------