Provider Demographics
NPI:1023725728
Name:MKWEZALAMBA, HILDA
Entity type:Individual
Prefix:
First Name:HILDA
Middle Name:
Last Name:MKWEZALAMBA
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 1:810 CHICKORY DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-2101
Mailing Address - Country:US
Mailing Address - Phone:217-819-0573
Mailing Address - Fax:
Practice Address - Street 1:810 CHICKORY DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-2101
Practice Address - Country:US
Practice Address - Phone:217-819-0573
Practice Address - Fax:443-312-5613
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041400061163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation