Individual
MNYISEI ELAINE KAMVAZAANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2490 CENTRAL AVE, LAKE STATION, IN 46405-2122
(219) 763-8112
Mailing address
2396 BUTTERFLY LN, BERRIEN SPRINGS, MI 49103-8501
(269) 815-2444
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
71015457A
IN
Other
Enumeration date
07/25/2024
Last updated
07/25/2024
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