Individual
CHRISTIANE NWAWOCK MBIANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
710 PARK PL, MISHAWAKA, IN 46545-3519
(574) 273-6787
(574) 968-7160
Mailing address
PO BOX 5909, PORTLAND, OR 97228-5909
(574) 273-6767
(749) 687-1605
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01075238A
IN
207RN0300X
Nephrology Physician
Primary
01075238A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201291860
—
IN
Enumeration date
04/02/2010
Last updated
04/02/2020
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