Provider Demographics
NPI:1619144862
Name:NKULU, RHIA CLEMENTE (RN)
Entity Type:Individual
Prefix:
First Name:RHIA
Middle Name:CLEMENTE
Last Name:NKULU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARIA LUZ
Other - Middle Name:GONZALES
Other - Last Name:NKULU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1332 W WAHALLA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4332
Mailing Address - Country:US
Mailing Address - Phone:623-242-7894
Mailing Address - Fax:
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527105163W00000X
IL041-280152163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
No163W00000XNursing Service ProvidersRegistered Nurse