Provider Demographics
NPI:1417727496
Name:MWIMBE, GIVEN M (AGNP)
Entity Type:Individual
Prefix:
First Name:GIVEN
Middle Name:M
Last Name:MWIMBE
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SAINT JOSEPH TER
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-2614
Mailing Address - Country:US
Mailing Address - Phone:732-841-0162
Mailing Address - Fax:
Practice Address - Street 1:3 SAINT JOSEPH TER
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2614
Practice Address - Country:US
Practice Address - Phone:732-841-0162
Practice Address - Fax:732-634-1811
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14981000207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine