Provider Demographics
NPI:1750695235
Name:MWENGE, TUNDA IZZA (APN)
Entity type:Individual
Prefix:MISS
First Name:TUNDA
Middle Name:IZZA
Last Name:MWENGE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 DUNELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:DUNELLEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1028
Mailing Address - Country:US
Mailing Address - Phone:973-342-0518
Mailing Address - Fax:
Practice Address - Street 1:725 DUNELLEN AVE
Practice Address - Street 2:
Practice Address - City:DUNELLEN
Practice Address - State:NJ
Practice Address - Zip Code:08812-1028
Practice Address - Country:US
Practice Address - Phone:973-342-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01036900363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care