Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 2012026433 | MO |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 75490 | KS |
NPI | 1003186719 |
---|---|
Provider Name | Mrs. Judith Khalamwa Nandwa |
First Address | Kansas City, KS 66160-0001 |
Second Address | Kansas City, KS 66160-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2012 |
Last Update Date | 28/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003186719 | (05) | MO |
200869500A | (05) | KS |