Provider Demographics
NPI:1396278495
Name:MWAMBURI, MKAYA
Entity type:Individual
Prefix:
First Name:MKAYA
Middle Name:
Last Name:MWAMBURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 PACKER CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-7017
Mailing Address - Country:US
Mailing Address - Phone:617-281-8696
Mailing Address - Fax:
Practice Address - Street 1:2706 PACKER CT
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-7017
Practice Address - Country:US
Practice Address - Phone:617-281-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide