Provider Demographics
NPI:1588011712
Name:NAKUMA, MAVIS (RN-BSN)
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:NAKUMA
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 KNIGHT CIR
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2113
Mailing Address - Country:US
Mailing Address - Phone:864-653-5468
Mailing Address - Fax:
Practice Address - Street 1:115 KNIGHT CIR
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2113
Practice Address - Country:US
Practice Address - Phone:864-653-5468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC212431163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse