Provider Demographics
NPI:1942864095
Name:MOKONYAMA, ANNE MUTHONI (CRNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MUTHONI
Last Name:MOKONYAMA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MUTHONI
Other - Last Name:WAITHERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 NUTT RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3900
Mailing Address - Country:US
Mailing Address - Phone:610-983-1601
Mailing Address - Fax:
Practice Address - Street 1:140 NUTT RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3900
Practice Address - Country:US
Practice Address - Phone:610-983-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty