Provider Demographics
NPI:1063984144
Name:KAMARA, RUTH ALICE (RN)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ALICE
Last Name:KAMARA
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 1:12606 NICHOLS PROMISE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5602
Mailing Address - Country:US
Mailing Address - Phone:240-464-5300
Mailing Address - Fax:240-464-5301
Practice Address - Street 1:12606 NICHOLS PROMISE DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5602
Practice Address - Country:US
Practice Address - Phone:240-464-5300
Practice Address - Fax:240-464-5301
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169958163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4725551978Other163WOOOOX