Provider Demographics
NPI:1407210156
Name:MURANJA, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MURANJA
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 1:836 REGISTRY TER NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2854
Mailing Address - Country:US
Mailing Address - Phone:770-827-5291
Mailing Address - Fax:
Practice Address - Street 1:836 REGISTRY TER NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-2854
Practice Address - Country:US
Practice Address - Phone:770-827-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ293164163WP0808X
GA209085363LF0000X
GARN20985163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily