Provider Demographics
NPI:1952001778
Name:MBALUKA, PENINAH MUTHUE
Entity Type:Individual
Prefix:DR
First Name:PENINAH
Middle Name:MUTHUE
Last Name:MBALUKA
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 1:602 MELANIE CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3575
Mailing Address - Country:US
Mailing Address - Phone:609-346-0026
Mailing Address - Fax:856-513-3776
Practice Address - Street 1:602 MELANIE CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-3575
Practice Address - Country:US
Practice Address - Phone:609-346-0026
Practice Address - Fax:856-243-5675
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14204600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse