Provider Demographics
NPI:1326788654
Name:MMUNGA, JEANETTE AMISI
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:AMISI
Last Name:MMUNGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:AMISI
Other - Last Name:MUIBI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2869 NE SANDY BLVD APT 216
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2454
Mailing Address - Country:US
Mailing Address - Phone:971-280-9825
Mailing Address - Fax:
Practice Address - Street 1:9205 E BURNSIDE ST APT 208
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-1571
Practice Address - Country:US
Practice Address - Phone:971-280-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula