Provider Demographics
NPI:1376371708
Name:KAMVAZAANA, MNYISEI ELAINE (NP)
Entity type:Individual
Prefix:
First Name:MNYISEI
Middle Name:ELAINE
Last Name:KAMVAZAANA
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:2396 BUTTERFLY LN
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-8501
Mailing Address - Country:US
Mailing Address - Phone:269-815-2444
Mailing Address - Fax:
Practice Address - Street 1:2490 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAKE STATION
Practice Address - State:IN
Practice Address - Zip Code:46405-2122
Practice Address - Country:US
Practice Address - Phone:219-763-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71015457A363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology