Healthcare Provider Details

I. General information

NPI: 1063387926
Provider Name (Legal Business Name): MARY KAMAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S CEDAR CREST BLVD STE 310
ALLENTOWN PA
18103-6381
US

IV. Provider business mailing address

2573 DANIELS LN
QUAKERTOWN PA
18951-5075
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-6890
  • Fax:
Mailing address:
  • Phone: 484-935-2699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP034121
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberSP034121
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: