Provider Demographics
NPI:1487180220
Name:NJUMBWA, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:NJUMBWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:FOMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2727 CULVER RD APT 21
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2831
Mailing Address - Country:US
Mailing Address - Phone:585-413-0990
Mailing Address - Fax:
Practice Address - Street 1:2727 CULVER RD APT 21
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2831
Practice Address - Country:US
Practice Address - Phone:585-413-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323616164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse