Provider Demographics
NPI:1093379059
Name:KAMUTI, LUBASI SR (RN, PHN)
Entity type:Individual
Prefix:
First Name:LUBASI
Middle Name:
Last Name:KAMUTI
Suffix:SR
Gender:M
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1662
Mailing Address - Country:US
Mailing Address - Phone:612-230-0737
Mailing Address - Fax:651-229-5399
Practice Address - Street 1:726 2ND ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1662
Practice Address - Country:US
Practice Address - Phone:763-230-0737
Practice Address - Fax:651-229-5399
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2471610163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent