Provider Demographics
NPI:1356162176
Name:KIMANDI, EVELYN (CNA)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:KIMANDI
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15845 NE 51ST ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5242
Mailing Address - Country:US
Mailing Address - Phone:404-348-3658
Mailing Address - Fax:
Practice Address - Street 1:15845 NE 51ST ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5242
Practice Address - Country:US
Practice Address - Phone:404-348-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0030083950376K00000X
WA61466393376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide