Provider Demographics
NPI:1336815562
Name:MWANGA, ALEXANDRIA W (DNP, FNP-C)
Entity type:Individual
Prefix:MR
First Name:ALEXANDRIA
Middle Name:W
Last Name:MWANGA
Suffix:
Gender:M
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:MWANGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, FNP-C
Mailing Address - Street 1:1965 S EAGLE RD STE 180
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9246
Mailing Address - Country:US
Mailing Address - Phone:986-666-3866
Mailing Address - Fax:986-666-3038
Practice Address - Street 1:2321 E GALA ST STE 3
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7692
Practice Address - Country:US
Practice Address - Phone:208-888-5848
Practice Address - Fax:208-888-0884
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID69372171400000X, 207Q00000X, 208D00000X, 208M00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty