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Individual
MAMIE MUKUNDI MANDELA
Active
Individual
MAMIE MUKUNDI MANDELA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
95010871
CA
363LP2300X
Primary Care Nurse Practitioner
Primary
95010871
CA
Other
Enumeration date
12/21/2018
Last updated
06/14/2019
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