Provider Demographics
NPI:1912640616
Name:GITHINJI, LAURAH WAMBUI
Entity Type:Individual
Prefix:MRS
First Name:LAURAH
Middle Name:WAMBUI
Last Name:GITHINJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3371 MALCOM CT SW
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-3317
Mailing Address - Country:US
Mailing Address - Phone:952-297-6685
Mailing Address - Fax:
Practice Address - Street 1:3371 MALCOM CT SW
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-3317
Practice Address - Country:US
Practice Address - Phone:952-297-6685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver