Provider Demographics
NPI:1316134463
Name:MWEMBI, CAROLINE KWAMBOKA
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:KWAMBOKA
Last Name:MWEMBI
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 1:7371 159TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-6617
Mailing Address - Country:US
Mailing Address - Phone:763-670-9704
Mailing Address - Fax:763-862-7438
Practice Address - Street 1:7371 159TH AVE NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-6617
Practice Address - Country:US
Practice Address - Phone:763-670-9704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR208505-2163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse