Provider Demographics
NPI:1487343562
Name:KIMEMIA, JOYCE WANGUI (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:WANGUI
Last Name:KIMEMIA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11137 FILLMORE ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4524
Mailing Address - Country:US
Mailing Address - Phone:651-278-5406
Mailing Address - Fax:
Practice Address - Street 1:11137 FILLMORE ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4524
Practice Address - Country:US
Practice Address - Phone:651-278-5406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR196625-3163WH0200X, 163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health