Healthcare Provider Details

I. General information

NPI: 1770453391
Provider Name (Legal Business Name): LEA GUYLAINE KICHINDJA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2025
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6634 E GARDENIA LN
NAMPA ID
83687-4903
US

IV. Provider business mailing address

6634 E GARDENIA LN
NAMPA ID
83687-4903
US

V. Phone/Fax

Practice location:
  • Phone: 301-531-0444
  • Fax:
Mailing address:
  • Phone: 301-531-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: