Provider Demographics
NPI:1740923663
Name:SAIBOU, KEMBA (RN)
Entity type:Individual
Prefix:MS
First Name:KEMBA
Middle Name:
Last Name:SAIBOU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 WOODHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1205
Mailing Address - Country:US
Mailing Address - Phone:240-308-8786
Mailing Address - Fax:
Practice Address - Street 1:4107 WOODHAVEN LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1205
Practice Address - Country:US
Practice Address - Phone:240-308-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR239737163WM0102X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn