Provider Demographics
NPI:1285520429
Name:KUDERHA, MAOMBI JOSELYNE
Entity type:Individual
Prefix:
First Name:MAOMBI
Middle Name:JOSELYNE
Last Name:KUDERHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 CADENCE LN APT 2221
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-2407
Mailing Address - Country:US
Mailing Address - Phone:682-217-7115
Mailing Address - Fax:
Practice Address - Street 1:3332 CADENCE LN APT 2221
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-2407
Practice Address - Country:US
Practice Address - Phone:682-217-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide