Provider Demographics
NPI:1770998205
Name:MWANGI, TERESIAH N (DNP, APRN)
Entity type:Individual
Prefix:
First Name:TERESIAH
Middle Name:N
Last Name:MWANGI
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W MOCKINGBIRD LN
Mailing Address - Street 2:STE 550
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4902
Mailing Address - Country:US
Mailing Address - Phone:469-904-3555
Mailing Address - Fax:214-819-2405
Practice Address - Street 1:1250 W MOCKINGBIRD LN
Practice Address - Street 2:STE 550
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4902
Practice Address - Country:US
Practice Address - Phone:469-904-3555
Practice Address - Fax:214-819-2405
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH-118458363L00000X
IAJ-118458363L00000X
TXAP127814363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX495196YLPSOtherWELLMED MEDICAL GROUP PA