Provider Demographics
NPI:1548905011
Name:WANJIRU, ROBERT WAIYAKI
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WAIYAKI
Last Name:WANJIRU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SIMPLY COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-5184
Mailing Address - Country:US
Mailing Address - Phone:919-335-5435
Mailing Address - Fax:
Practice Address - Street 1:110 SIMPLY COUNTRY LN
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-5184
Practice Address - Country:US
Practice Address - Phone:919-335-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)