Provider Demographics
NPI:1265845275
Name:KAMUNDI, IAN NYAGA
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:NYAGA
Last Name:KAMUNDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2101
Mailing Address - Country:US
Mailing Address - Phone:612-343-4004
Mailing Address - Fax:612-343-4007
Practice Address - Street 1:1433 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2101
Practice Address - Country:US
Practice Address - Phone:612-343-4004
Practice Address - Fax:612-343-4007
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 219215-2163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse