MEDICARE: EVELYNE MUGO RN

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	163W00000X	Registered Nurse	95427728	MD

General Provider Information

NPI Number	:	1699619635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYNE MUGO RN

Provider Business Mailing Address
First Line	:	PO BOX 581452
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-0025
Country	:	US
Telephone Number	:	916-542-0003
Fax Number	:

Provider Business Practice Location Address
First Line	:	7940 GIMRON WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-8454
Country	:	US
Telephone Number	:	916-542-0003
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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