Provider Demographics
NPI:1942891791
Name:MBOTE, NELLIE WAMBUI (RN, BSN)
Entity Type:Individual
Prefix:
First Name:NELLIE
Middle Name:WAMBUI
Last Name:MBOTE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 SW FLINTROCK DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4871
Mailing Address - Country:US
Mailing Address - Phone:816-209-9237
Mailing Address - Fax:
Practice Address - Street 1:4012 SW FLINTROCK DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4871
Practice Address - Country:US
Practice Address - Phone:816-209-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015027846163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse