Provider Demographics
NPI:1154790509
Name:KAMARA, MEMUNA (NP)
Entity type:Individual
Prefix:
First Name:MEMUNA
Middle Name:
Last Name:KAMARA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MUNAHAN CIR UNIT A
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD
Mailing Address - State:MD
Mailing Address - Zip Code:20640-1486
Mailing Address - Country:US
Mailing Address - Phone:301-801-4178
Mailing Address - Fax:
Practice Address - Street 1:319 MUNAHAN CIRCLE UNIT A
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640
Practice Address - Country:US
Practice Address - Phone:301-801-4178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1006853363L00000X
MDR169868363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner