MEDICARE: JACINTA WANGUI DNP, FNP-C, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G182031	IA
2	363LF0000X	Family Nurse Practitioner	A131289	IA

General Provider Information

NPI Number	:	1447769880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACINTA WANGUI DNP, FNP-C, PMHNP-BC

Provider Business Mailing Address
First Line	:	1706 W AGENCY RD
Second Line	:
City	:	WEST BURLINGTON
State	:	IA
Zip	:	52655-1667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 SPRING ST
Second Line	:
City	:	COLUMBUS CITY
State	:	IA
Zip	:	52737-9302
Country	:	US
Telephone Number	:	319-728-7400
Fax Number	:	319-728-7404

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

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	11/18/2024

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