Provider Demographics
NPI:1154217966
Name:MWAI, ELIZBETH W
Entity type:Individual
Prefix:
First Name:ELIZBETH
Middle Name:W
Last Name:MWAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 SPICEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4732
Mailing Address - Country:US
Mailing Address - Phone:214-407-4395
Mailing Address - Fax:
Practice Address - Street 1:14211 DRY CREEK ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-9107
Practice Address - Country:US
Practice Address - Phone:214-407-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95412664163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse