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General NPI Number Information
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NPI Number | 1720749930
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Entity Type | Individual
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Provider Name | REBECCA N WANJOGA AG ACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 914 GRANDVIEW WAY NW
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City | ACWORTH
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State | GA
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Zip | 30101-7842
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Country | US
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Telephone | 678-907-4776
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Fax |
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Provider Business Mailing Address
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Address Line | 914 GRANDVIEW WAY NW
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City | ACWORTH
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State | GA
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Zip | 30101-7842
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Country | US
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Telephone |
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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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | AC004072
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License Number State | MD
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