Provider Demographics
NPI:1851174312
Name:NAMBO, KAREN KAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:KAY
Last Name:NAMBO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 EASTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2216
Mailing Address - Country:US
Mailing Address - Phone:815-962-0871
Mailing Address - Fax:815-962-7895
Practice Address - Street 1:215 EASTON PKWY
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2216
Practice Address - Country:US
Practice Address - Phone:815-962-0871
Practice Address - Fax:815-962-7895
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041368248163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse