Provider Demographics
NPI:1285942987
Name:MAAMBO, NCHIMUNYA M (PA-C)
Entity type:Individual
Prefix:MR
First Name:NCHIMUNYA
Middle Name:M
Last Name:MAAMBO
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:13808 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7948
Mailing Address - Country:US
Mailing Address - Phone:704-377-4009
Mailing Address - Fax:704-602-6531
Practice Address - Street 1:13808 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7948
Practice Address - Country:US
Practice Address - Phone:704-377-4009
Practice Address - Fax:704-602-6531
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDT0004301363AM0700X
WAPA60225024363AM0700X
NC0010-04207363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical