Provider Demographics
NPI:1538459904
Name:MWANIA, ROSE M (CRNA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:MWANIA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:MWANIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1004 PARKWAY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9349
Mailing Address - Country:US
Mailing Address - Phone:574-522-9922
Mailing Address - Fax:574-522-9926
Practice Address - Street 1:1004 PARKWAY AVE STE A
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516
Practice Address - Country:US
Practice Address - Phone:574-522-9922
Practice Address - Fax:574-522-9926
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28212657A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered