Provider Demographics
NPI:1689747164
Name:KAMARA, MAKEDA (CNM, MPH, MED)
Entity Type:Individual
Prefix:MS
First Name:MAKEDA
Middle Name:
Last Name:KAMARA
Suffix:
Gender:F
Credentials:CNM, MPH, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 DRACUT ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3818
Mailing Address - Country:US
Mailing Address - Phone:617-282-9783
Mailing Address - Fax:617-282-9783
Practice Address - Street 1:39 DRACUT ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3818
Practice Address - Country:US
Practice Address - Phone:617-282-9783
Practice Address - Fax:617-282-9783
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199759363LX0001X, 364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health