Provider Demographics
NPI:1710254644
Name:TERESIAH MWANGI
Entity Type:Organization
Organization Name:TERESIAH MWANGI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TERESIAH
Authorized Official - Middle Name:NJERI
Authorized Official - Last Name:MWANGI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:319-354-6185
Mailing Address - Street 1:2519 ASTER AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6734
Mailing Address - Country:US
Mailing Address - Phone:319-354-6185
Mailing Address - Fax:
Practice Address - Street 1:2519 ASTER AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6734
Practice Address - Country:US
Practice Address - Phone:319-354-6185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH118458261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center