Healthcare Provider Details

I. General information

NPI: 1508777814
Provider Name (Legal Business Name): MISHAEL KIEMA MBITHUKA RN-BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PARKSHORE DR STE 100
FOLSOM CA
95630-4726
US

IV. Provider business mailing address

4531 TRIPLE CREEK CT
FOLSOM CA
95630-7080
US

V. Phone/Fax

Practice location:
  • Phone: 701-730-6191
  • Fax:
Mailing address:
  • Phone: 701-730-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95350753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: