Provider Demographics
NPI:1043996051
Name:MUGOMBA, MUCHENGETI NYASHA (RN)
Entity Type:Individual
Prefix:
First Name:MUCHENGETI
Middle Name:NYASHA
Last Name:MUGOMBA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 MOON ST NE APT 2424
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1457
Mailing Address - Country:US
Mailing Address - Phone:615-424-3767
Mailing Address - Fax:
Practice Address - Street 1:6001 MOON ST NE APT 2424
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1457
Practice Address - Country:US
Practice Address - Phone:615-424-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM57459163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse