Provider Demographics
NPI:1881948727
Name:KAMARA, KADIJATU (LPN)
Entity type:Individual
Prefix:MRS
First Name:KADIJATU
Middle Name:
Last Name:KAMARA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 MONECA ST
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9034
Mailing Address - Country:US
Mailing Address - Phone:614-425-6625
Mailing Address - Fax:
Practice Address - Street 1:1145 MONECA ST
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9034
Practice Address - Country:US
Practice Address - Phone:614-425-6625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147858164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse