Provider Demographics
NPI:1366128357
Name:NUNGARI, ROSEANNE MUTHONI (RN)
Entity type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:MUTHONI
Last Name:NUNGARI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16945 RAIL WAY
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-8641
Mailing Address - Country:US
Mailing Address - Phone:925-858-2694
Mailing Address - Fax:
Practice Address - Street 1:16945 RAIL WAY
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-8641
Practice Address - Country:US
Practice Address - Phone:925-858-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA843718163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse