Provider Demographics
NPI:1417735580
Name:WANJIKU, LOISE MUTHONI
Entity Type:Individual
Prefix:
First Name:LOISE
Middle Name:MUTHONI
Last Name:WANJIKU
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 1:8264 GRAND CRU DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-9515
Mailing Address - Country:US
Mailing Address - Phone:206-913-1006
Mailing Address - Fax:
Practice Address - Street 1:8264 GRAND CRU DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-9515
Practice Address - Country:US
Practice Address - Phone:206-913-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95199181163WC3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC3500XNursing Service ProvidersRegistered NurseCardiac RehabilitationGroup - Single Specialty