Healthcare Provider Details

I. General information

NPI: 1346527876
Provider Name (Legal Business Name): HENRY WAITE KURUMBU RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LAKESIDE DR
OAKLAND CA
94612-4620
US

IV. Provider business mailing address

1 LAKESIDE DR APT 803
OAKLAND CA
94612-4656
US

V. Phone/Fax

Practice location:
  • Phone: 952-688-2026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 183466-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: