Healthcare Provider Details

I. General information

NPI: 1417411711
Provider Name (Legal Business Name): GLORIA KAY KAMMERMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 LAFAYETTE DR
HILLSBOROUGH NC
27278-9344
US

IV. Provider business mailing address

1010 N 102ND ST STE 300
OMAHA NE
68114-2122
US

V. Phone/Fax

Practice location:
  • Phone: 919-260-9141
  • Fax:
Mailing address:
  • Phone: 866-633-3548
  • Fax: 866-688-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number102392
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number102392
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: