Provider Demographics
NPI:1457655037
Name:MAINA, DAMARIS MUKINA (LPN)
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:MUKINA
Last Name:MAINA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3734 REVOLUTIONARY DR.
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-6544
Mailing Address - Country:US
Mailing Address - Phone:614-598-1166
Mailing Address - Fax:
Practice Address - Street 1:3734 REVOLUTIONARY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-6544
Practice Address - Country:US
Practice Address - Phone:614-598-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN136997164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse