Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NCO-000003 | GA |
NPI | 1033606165 |
---|---|
Provider Name | Jane Wanjiru Waweru |
First Address | Atlanta, GA 30339-2438 |
Second Address | Atlanta, GA 30339-2438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2018 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000000000 | NO OTHER NUMBERS (01) |