Provider Demographics
NPI:1437957776
Name:MWALUNGO, MATILDA
Entity type:Individual
Prefix:
First Name:MATILDA
Middle Name:
Last Name:MWALUNGO
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 1:8364 ROCKLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7361
Mailing Address - Country:US
Mailing Address - Phone:909-557-0848
Mailing Address - Fax:
Practice Address - Street 1:8364 ROCKLEDGE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-7361
Practice Address - Country:US
Practice Address - Phone:909-557-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant