Provider Demographics
NPI:1710415559
Name:MURIITHI, JOSEPH K (ACNPC-AG)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:K
Last Name:MURIITHI
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PARK PLACE CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3585
Mailing Address - Country:US
Mailing Address - Phone:574-607-4724
Mailing Address - Fax:
Practice Address - Street 1:515 PARK PLACE CIR STE 200
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3585
Practice Address - Country:US
Practice Address - Phone:574-607-4724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007277A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300007827Medicaid
IN000001098390OtherANTHEM