Provider Demographics
NPI:1063228047
Name:MUNYATI, KUDAKWASHE VICTORIA (CNA)
Entity type:Individual
Prefix:
First Name:KUDAKWASHE
Middle Name:VICTORIA
Last Name:MUNYATI
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 UNIVERSITY DR N STE 390
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4661
Mailing Address - Country:US
Mailing Address - Phone:701-781-0893
Mailing Address - Fax:
Practice Address - Street 1:112 UNIVERSITY DR N STE 390
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4661
Practice Address - Country:US
Practice Address - Phone:701-781-0893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND85778376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty