Active NPI
Mary Ann Mwenja
- Respite Care
- Mesa, AZ
National Provider Identifier
1245753383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Respite Care
- License
- BH5129
- Practice address
- 1302 S Rico
Mesa, AZ 85204-6349 - Phone
- (480) 300-1432
- NPI assigned
- Jul 20, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Respite Care | 385H00000X | BH5129 | AZ | Primary |
Addresses
Primary practice location
1302 S Rico
Mesa, AZ 85204-6349
Mailing address
1302 S Rico
Mesa, AZ 85204-6349
Phone (480) 300-1432
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BH5129 | Other | AZ | AZ DEPT OF HEALTH SERVICES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BH5129 | AZ | MD | Respite Care |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1245753383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1302 S RICO",
"city": "MESA",
"state": "AZ",
"postal_code": "852046349",
"telephone_number": "480-300-1432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1302 S RICO",
"city": "MESA",
"state": "AZ",
"postal_code": "852046349",
"telephone_number": "480-300-1432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MWENJA",
"first_name": "MARY",
"middle_name": "ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-20",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "385H00000X",
"taxonomy_group": "",
"desc": "Respite Care",
"state": "AZ",
"license": "BH5129",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AZ DEPT OF HEALTH SERVICES",
"identifier": "BH5129",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.