Provider Demographics
NPI:1245638048
Name:NGUGI, JOHN KAMAU (CRNP-BC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KAMAU
Last Name:NGUGI
Suffix:
Gender:M
Credentials:CRNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72098
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-8098
Mailing Address - Country:US
Mailing Address - Phone:480-878-7806
Mailing Address - Fax:
Practice Address - Street 1:1314 BEDFORD AVE STE 113
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3737
Practice Address - Country:US
Practice Address - Phone:480-877-8780
Practice Address - Fax:443-732-0054
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR179125363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD964007000Medicaid