Provider Demographics
NPI:1124606959
Name:MWANGI, BERNICE
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:MWANGI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8821 GOOSE LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2179
Mailing Address - Country:US
Mailing Address - Phone:443-577-8050
Mailing Address - Fax:
Practice Address - Street 1:8821 GOOSE LANDING CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2179
Practice Address - Country:US
Practice Address - Phone:443-577-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date: