Provider Demographics
NPI:1669103750
Name:MWAJUMA, JOLIE (CPR CERTIFIED)
Entity type:Individual
Prefix:
First Name:JOLIE
Middle Name:
Last Name:MWAJUMA
Suffix:
Gender:F
Credentials:CPR CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 N ASTER PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8022
Mailing Address - Country:US
Mailing Address - Phone:208-570-2422
Mailing Address - Fax:
Practice Address - Street 1:1273 N ASTER PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8022
Practice Address - Country:US
Practice Address - Phone:208-570-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA