Provider Demographics
NPI:1619515020
Name:JAMA, DEKHA
Entity Type:Individual
Prefix:
First Name:DEKHA
Middle Name:
Last Name:JAMA
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 1:2003 10TH AVE S STE 6
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-6606
Mailing Address - Country:US
Mailing Address - Phone:614-377-1864
Mailing Address - Fax:
Practice Address - Street 1:2003 10TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-6605
Practice Address - Country:US
Practice Address - Phone:614-377-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3747P1801X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant