Provider Demographics
NPI:1952185084
Name:MUCHEMI, MERCY WANGECHI
Entity Type:Individual
Prefix:MS
First Name:MERCY
Middle Name:WANGECHI
Last Name:MUCHEMI
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 1:803 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3233
Mailing Address - Country:US
Mailing Address - Phone:323-348-0148
Mailing Address - Fax:
Practice Address - Street 1:803 MANCHESTER DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3233
Practice Address - Country:US
Practice Address - Phone:323-348-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28276544C163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse