Provider Demographics
NPI:1609533298
Name:KANEMA, KATENDI (APRN)
Entity Type:Individual
Prefix:
First Name:KATENDI
Middle Name:
Last Name:KANEMA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52021 CLOVERLEAF DR W
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-6034
Mailing Address - Country:US
Mailing Address - Phone:574-231-6766
Mailing Address - Fax:833-249-2411
Practice Address - Street 1:6910 N MAIN ST UNIT 52
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8412
Practice Address - Country:US
Practice Address - Phone:574-231-6766
Practice Address - Fax:833-249-2411
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011886A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71011866AOtherAPRN LICENSE