Provider Demographics
NPI:1629578562
Name:KAMAU, JUDY W
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:W
Last Name:KAMAU
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 1:700 CUSTER RD APT 174
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5148
Mailing Address - Country:US
Mailing Address - Phone:214-861-0210
Mailing Address - Fax:
Practice Address - Street 1:700 CUSTER RD APT 174
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5148
Practice Address - Country:US
Practice Address - Phone:214-861-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310531164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse