Provider Demographics
NPI:1396519302
Name:KIMANI, CHARLES MAINA (RN BSN)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MAINA
Last Name:KIMANI
Suffix:
Gender:M
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 1:4393 INDIGO ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-2137
Mailing Address - Country:US
Mailing Address - Phone:503-393-0590
Mailing Address - Fax:503-966-3990
Practice Address - Street 1:4393 INDIGO ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-2137
Practice Address - Country:US
Practice Address - Phone:503-393-0590
Practice Address - Fax:503-966-3990
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202103475RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty