Provider Demographics
NPI:1790026136
Name:MWONGELA, JAMIE L
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:MWONGELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 ESSEX CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3642
Mailing Address - Country:US
Mailing Address - Phone:913-596-8720
Mailing Address - Fax:
Practice Address - Street 1:923 ESSEX CT
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3642
Practice Address - Country:US
Practice Address - Phone:913-596-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula