Provider Demographics
NPI:1730681602
Name:MWANIA, NANCY W
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:W
Last Name:MWANIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42107 ALEXANDRA DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-3485
Mailing Address - Country:US
Mailing Address - Phone:949-295-5345
Mailing Address - Fax:
Practice Address - Street 1:42107 ALEXANDRA DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-3485
Practice Address - Country:US
Practice Address - Phone:949-295-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007987207Q00000X, 363LP2300X
CA714581163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care