MEDICARE: CHARLES MWANGO

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	374T00000X	Religious Nonmedical Nursing Personnel
2	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1437408986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MWANGO

Provider Business Mailing Address
First Line	:	3800 S FLAMINGO RD
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33330-1616
Country	:	US
Telephone Number	:	954-473-0167
Fax Number	:	954-473-0202

Provider Business Practice Location Address
First Line	:	3800 S FLAMINGO RD
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33330-1616
Country	:	US
Telephone Number	:	954-473-0167
Fax Number	:	954-473-0202

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

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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Directions to “ CHARLES MWANGO ” Practice Location

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