Provider Demographics
NPI:1003250192
Name:NANKU, KAMLA
Entity Type:Individual
Prefix:
First Name:KAMLA
Middle Name:
Last Name:NANKU
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 1:1755 EASTBURN AVE
Mailing Address - Street 2:C2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-6964
Mailing Address - Country:US
Mailing Address - Phone:718-459-5592
Mailing Address - Fax:
Practice Address - Street 1:1755 EASTBURN AVE
Practice Address - Street 2:C2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-6964
Practice Address - Country:US
Practice Address - Phone:718-459-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313842-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse