Provider Demographics
NPI:1053552232
Name:WANJORAH, JENELICAH WANGUI (RN)
Entity type:Individual
Prefix:MS
First Name:JENELICAH
Middle Name:WANGUI
Last Name:WANJORAH
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 1:24 NASSAU RD
Mailing Address - Street 2:APT# 3
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1612
Mailing Address - Country:US
Mailing Address - Phone:570-604-4003
Mailing Address - Fax:
Practice Address - Street 1:24 NASSAU RD
Practice Address - Street 2:APT# 3
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1612
Practice Address - Country:US
Practice Address - Phone:570-604-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614353-1163W00000X
PARN600255163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse