Provider Demographics
NPI:1609496173
Name:KIMOTHO, EDITH NYAMBURA
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:NYAMBURA
Last Name:KIMOTHO
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 1:102 HARVEST BEND DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4514
Mailing Address - Country:US
Mailing Address - Phone:469-782-4241
Mailing Address - Fax:
Practice Address - Street 1:102 HARVEST BEND DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4514
Practice Address - Country:US
Practice Address - Phone:469-782-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352608164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse