Provider Demographics
NPI:1982462909
Name:MULENGA, MALISENI MPUNDU (CRNP)
Entity Type:Individual
Prefix:
First Name:MALISENI
Middle Name:MPUNDU
Last Name:MULENGA
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 KINGS HWY LOT 7
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17053-9406
Mailing Address - Country:US
Mailing Address - Phone:717-307-0512
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:800-243-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner