Provider Demographics
NPI:1982390167
Name:MWANZA, ALICE NDUKU (NP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:NDUKU
Last Name:MWANZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 S 90TH DR
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-5904
Mailing Address - Country:US
Mailing Address - Phone:623-256-0851
Mailing Address - Fax:
Practice Address - Street 1:3023 S 90TH DR
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-5904
Practice Address - Country:US
Practice Address - Phone:623-256-0851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ290418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine