Provider Demographics
NPI:1770942708
Name:MUPUNGA, CHOOLWE VIRGINIA (NPF)
Entity type:Individual
Prefix:
First Name:CHOOLWE
Middle Name:VIRGINIA
Last Name:MUPUNGA
Suffix:
Gender:F
Credentials:NPF
Other - Prefix:
Other - First Name:CHOOLWE
Other - Middle Name:VIRGINIA
Other - Last Name:HAAMAKALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:520 COUNTRY CLUB
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6036
Mailing Address - Country:US
Mailing Address - Phone:541-683-5001
Mailing Address - Fax:541-683-1422
Practice Address - Street 1:520 COUNTRY CLUB
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6036
Practice Address - Country:US
Practice Address - Phone:541-683-5001
Practice Address - Fax:541-683-1422
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704245005363LF0000X
OR201905761NP-PP363LF0000X
TX1063610363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500766690Medicaid