Provider Demographics
NPI:1689161283
Name:KIFFA, ROSEMARY NSUM
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:NSUM
Last Name:KIFFA
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 1:2823 SHADOW CANYON LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2425
Mailing Address - Country:US
Mailing Address - Phone:832-661-6977
Mailing Address - Fax:
Practice Address - Street 1:2823 SHADOW CANYON LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2425
Practice Address - Country:US
Practice Address - Phone:832-661-6977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX735781163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherN/A