Provider Demographics
NPI:1578296984
Name:MWANGI, JACQUELINE W (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:W
Last Name:MWANGI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BROOKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1109
Mailing Address - Country:US
Mailing Address - Phone:434-227-8979
Mailing Address - Fax:
Practice Address - Street 1:121 BECKS WOODS DR STE 200
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3852
Practice Address - Country:US
Practice Address - Phone:302-834-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-03
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0044515163W00000X
MDAC004595363LF0000X
DELG-0012090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse