Provider Demographics
NPI:1407524507
Name:WAIRAGU, HANNAH NYAMBURA
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:NYAMBURA
Last Name:WAIRAGU
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 1:43 HALL ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7218
Mailing Address - Country:US
Mailing Address - Phone:607-723-1358
Mailing Address - Fax:
Practice Address - Street 1:43 HALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7218
Practice Address - Country:US
Practice Address - Phone:607-723-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.510023163W00000X
GARN229017367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse