Provider Demographics
NPI:1194566166
Name:KYELULA, AIDA (RN)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:
Last Name:KYELULA
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 1:629 CARDIFF
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-0879
Mailing Address - Country:US
Mailing Address - Phone:469-238-9505
Mailing Address - Fax:
Practice Address - Street 1:629 CARDIFF
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-0879
Practice Address - Country:US
Practice Address - Phone:469-238-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95282186163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse