Provider Demographics
NPI:1699195602
Name:KAMUDZANDU, RUTENDO (NP)
Entity Type:Individual
Prefix:
First Name:RUTENDO
Middle Name:
Last Name:KAMUDZANDU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RUTENDO
Other - Middle Name:
Other - Last Name:CHIUNDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19550 E 39TH ST S
Mailing Address - Street 2:SUITE 400B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2358
Mailing Address - Country:US
Mailing Address - Phone:816-795-7014
Mailing Address - Fax:816-795-7726
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 400B
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2358
Practice Address - Country:US
Practice Address - Phone:816-795-7014
Practice Address - Fax:816-795-7726
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014011352363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology