Provider Demographics
NPI:1770296451
Name:GATHUU, MARY WANJIKU (LVN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:WANJIKU
Last Name:GATHUU
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:1267 BEE BALM RD
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-8725
Mailing Address - Country:US
Mailing Address - Phone:951-379-2126
Mailing Address - Fax:
Practice Address - Street 1:1267 BEE BALM RD
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-8725
Practice Address - Country:US
Practice Address - Phone:951-379-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA718553164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse