Jackie Wanjiru-Nwuzor, CRNP-PMH

Primary specialty

Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X

License

404056 Issued in NY

Practice address

330 W 58TH St Apt 12H
New York, NY 10019-1834

Phone

(443) 768-5820

NPI assigned

Mar 29, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: jackiewanjirunwuzor.jackiewanjirunwuzor@154003.advancedmd-direct.com

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

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1992455117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 W 58TH ST APT 12H",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191834",
            "telephone_number": "443-768-5820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 W 58TH ST APT 12H",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191834",
            "telephone_number": "443-768-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANJIRU-NWUZOR",
        "first_name": "JACKIE",
        "credential": "CRNP-PMH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-29",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404056",
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404056",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R195623",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassie Lynn Wangsness, MS
• Wanho Lew DDS PLLC (Line Dental)
• Tony Wanich, MD
• Cristina Waniek, MD
• Ken Pongthorn Wanitchinda, FNP-C
• Bradley Joseph Wank, DDS
• Daniel Edward Wank, D.D.S.
• David Andrew Wank, DMD
• Jennifer Wank, PT, DPT
• Margot Jocelyn Wankoff, LMSW

• Psychiatric/Mental Health Clinical Nurse Specialist in New York, NY
• Providers in New York, NY by specialty
• Psychiatric/Mental Health Clinical Nurse Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.