Provider Demographics
NPI:1689765729
Name:MURAGE, WAMBUI JANE (NP)
Entity Type:Individual
Prefix:
First Name:WAMBUI
Middle Name:JANE
Last Name:MURAGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4880 CENTURY PLAZA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5469
Practice Address - Country:US
Practice Address - Phone:317-293-4113
Practice Address - Fax:317-290-2542
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001984363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
080159548Medicare PIN
IN151560F5Medicare PIN
IN152520RRMedicare PIN
INQ77309Medicare UPIN