Provider Demographics
NPI:1639755911
Name:KAMBE, NGAZUMU PATRICK
Entity Type:Individual
Prefix:
First Name:NGAZUMU
Middle Name:PATRICK
Last Name:KAMBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 W PASADENA DR APT 41
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-5080
Mailing Address - Country:US
Mailing Address - Phone:208-794-4625
Mailing Address - Fax:
Practice Address - Street 1:4400 W PASADENA DR APT 41
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-5080
Practice Address - Country:US
Practice Address - Phone:208-794-4625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health