Provider Demographics
NPI:1093980682
Name:MUKIAWA-SPANGLER, SHEILA NDI (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:NDI
Last Name:MUKIAWA-SPANGLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:MUKIAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:888-562-5442
Mailing Address - Fax:
Practice Address - Street 1:3000 CORPORATE EXCHANGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231
Practice Address - Country:US
Practice Address - Phone:888-562-5442
Practice Address - Fax:562-499-6171
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 123410 MEDS164W00000X
OHAPRN.CNP.022659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN123410 MEDSOtherLPN