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General NPI Number Information
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NPI Number | 1821477258
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Entity Type | Individual
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Provider Name | ROSELYNE A OGOLA-MWANGALE NP-C
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Gender | Female
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 5608 17TH AVE NW STE 1527
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City | SEATTLE
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State | WA
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Zip | 98107-5232
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Country | US
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Telephone | 206-612-1216
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Fax |
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Provider Business Mailing Address
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Address Line | 24463 W 10 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-2931
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Country | US
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Telephone | 248-829-9692
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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 | 4704296484
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704296484
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61285822
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License Number State | WA
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