Irene Mudehwe, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP60909301 Issued in WA

Practice address

784 14TH Ave
Longview, WA 98632-2315

Phone

(360) 703-6400

Fax

(360) 353-3611

NPI assigned

Nov 30, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543536000000",
    "number": "1750851846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 12TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322509",
            "telephone_number": "360-353-3256",
            "fax_number": "360-703-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "784 14TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322315",
            "telephone_number": "360-703-6400",
            "fax_number": "360-353-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDEHWE",
        "first_name": "IRENE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-30",
        "last_updated": "2018-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60909301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Michelle Moullet, PHARMD
• Mountain Smiles - Longview Dental, PLLC
• Mountain Smiles, PLLC
• Stevie L Moyer
• Ken Mubeen, AAC, CPC
• Sara Talal Muhtaseb, PA-C
• Joyce Mullen
• Allison Munkelwitz
• Christopher Munson, CPSS
• Hailee M Murfitt

• Family Nurse Practitioner in Longview, WA
• Providers in Longview, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.