Individual
MPHASA MWANZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
261 M 62, CASSOPOLIS, MI 49031-1034
(269) 445-3874
Mailing address
261 M 62, CASSOPOLIS, MI 49031-1034
(269) 445-3874
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
4704263078
MI
Other
Enumeration date
10/12/2015
Last updated
10/02/2019
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