Provider Demographics
NPI:1588895973
Name:KAMAU, MARYANNE WANGECI (LMBT)
Entity type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:WANGECI
Last Name:KAMAU
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 SANDY TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-9048
Mailing Address - Country:US
Mailing Address - Phone:919-217-5274
Mailing Address - Fax:
Practice Address - Street 1:7048 KNIGHTDALE BLVD
Practice Address - Street 2:SUITE 229
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8894
Practice Address - Country:US
Practice Address - Phone:919-217-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLMBT 4295225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist