Provider Demographics
NPI:1255822953
Name:KEMUNTO, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:KEMUNTO
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 1:3817 KENZIE CT
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-5012
Mailing Address - Country:US
Mailing Address - Phone:469-688-8404
Mailing Address - Fax:
Practice Address - Street 1:3817 KENZIE CT
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-5012
Practice Address - Country:US
Practice Address - Phone:469-688-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333589164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse