1588895973 NPI number — MS. MARYANNE WANGECI KAMAU LMBT

Table of content: MS. MARYANNE WANGECI KAMAU LMBT (NPI 1588895973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588895973 NPI number — MS. MARYANNE WANGECI KAMAU LMBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAMAU
Provider First Name:
MARYANNE
Provider Middle Name:
WANGECI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588895973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5537 SANDY TRAIL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNIGHTDALE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27545-9048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-217-5274
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7048 KNIGHTDALE BLVD
Provider Second Line Business Practice Location Address:
SUITE 229
Provider Business Practice Location Address City Name:
KNIGHTDALE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27545-8894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-217-5274
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  LMBT 4295 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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