Basic Information
Provider Information
NPI: 1558772137
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KARIUKI
FirstName: ELIZABETH
MiddleName: WANGARI
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 744785
Address2:  
City: ATLANTA
State: GA
PostalCode: 303744785
CountryCode: US
TelephoneNumber: 2024765000
FaxNumber:  
Practice Location
Address1: 111 MICHIGAN AVE NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200102916
CountryCode: US
TelephoneNumber: 2024765000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/16/2014
LastUpdateDate: 07/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080N0001X0101272351VAY Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine

No ID Information.


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