Provider Demographics
NPI:1124339569
Name:SHUMBA, KUDAKWASHE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KUDAKWASHE
Middle Name:
Last Name:SHUMBA
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 1:6355 STONEHENGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9786
Mailing Address - Country:US
Mailing Address - Phone:513-258-1893
Mailing Address - Fax:513-759-2783
Practice Address - Street 1:6355 STONEHENGE BLVD
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9786
Practice Address - Country:US
Practice Address - Phone:513-258-1893
Practice Address - Fax:513-759-2783
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH134344164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse