Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | R160930-3 | MN |
NPI | 1083027536 |
---|---|
Provider Name | Mueni C Mualuko |
First Address | Minneapolis, MN 55454-1321 |
Second Address | Minneapolis, MN 55454-1321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2014 |
Last Update Date | 03/06/2014 |