Provider Demographics
NPI:1093319766
Name:MANSEKA, MUKANDA MAMIE-CELINE (FNP)
Entity Type:Individual
Prefix:
First Name:MUKANDA
Middle Name:MAMIE-CELINE
Last Name:MANSEKA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30081-1251
Mailing Address - Country:US
Mailing Address - Phone:470-244-5601
Mailing Address - Fax:
Practice Address - Street 1:900 WYLIE RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7857
Practice Address - Country:US
Practice Address - Phone:770-427-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF11200019363LF0000X
GA269353163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty