Provider Demographics
NPI:1700472362
Name:KAMAU, VIVIAN WANGECHI (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:WANGECHI
Last Name:KAMAU
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 WINDERMERE CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4920
Mailing Address - Country:US
Mailing Address - Phone:443-717-1729
Mailing Address - Fax:
Practice Address - Street 1:400 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1872
Practice Address - Country:US
Practice Address - Phone:443-438-5610
Practice Address - Fax:443-438-5685
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212076363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health