Provider Demographics
NPI:1609219922
Name:MWANGI, FELISTER N (CRNA)
Entity Type:Individual
Prefix:
First Name:FELISTER
Middle Name:N
Last Name:MWANGI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 PIERPOINT LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4803
Mailing Address - Country:US
Mailing Address - Phone:314-698-1324
Mailing Address - Fax:
Practice Address - Street 1:1104 PIERPOINT LN
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-4803
Practice Address - Country:US
Practice Address - Phone:314-698-1324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.409046367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered