MEDICARE: JOB MWAURA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN6063597	WA

General Provider Information

NPI Number	:	1407628753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOB MWAURA

Provider Business Mailing Address
First Line	:	6518 187TH AVE E
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-8833
Country	:	US
Telephone Number	:	913-207-9114
Fax Number	:

Provider Business Practice Location Address
First Line	:	6518 187TH AVE E
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-8833
Country	:	US
Telephone Number	:	913-207-9114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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