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General NPI Number Information
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NPI Number | 1295303386
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Entity Type | Individual
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Provider Name | KEMUNTO MOKORA
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Gender | Female
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 313 JEFFERSON AVE
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City | TOLEDO
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State | OH
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Zip | 43604-1004
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Country | US
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Telephone | 419-720-7883
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Fax |
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Provider Business Mailing Address
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Address Line | 313 JEFFERSON AVE
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City | TOLEDO
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State | OH
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Zip | 43604-1004
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Country | US
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Telephone | 419-720-7883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704393156APP22
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0027696
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0027696
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 0027696
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License Number State | OH
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