Provider Demographics
NPI:1609383009
Name:WANGOI, PATRICK KITAMBO
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:KITAMBO
Last Name:WANGOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9604 W MILCLAY ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4100
Mailing Address - Country:US
Mailing Address - Phone:208-515-5685
Mailing Address - Fax:
Practice Address - Street 1:9604 W MILCLAY ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4100
Practice Address - Country:US
Practice Address - Phone:208-515-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty