MEDICARE: GERTRUDE MUMBA-KAUNDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71005367A	IN
2	363LF0000X	Family Nurse Practitioner	4704248992	MI

General Provider Information

NPI Number	:	1093146631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERTRUDE MUMBA-KAUNDA

Provider Business Mailing Address
First Line	:	8003 CASTLEWAY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1946
Country	:	US
Telephone Number	:	317-576-1335
Fax Number	:	844-397-1311

Provider Business Practice Location Address
First Line	:	1901 W WESTERN AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46619-3569
Country	:	US
Telephone Number	:	574-234-9033
Fax Number	:	844-397-1310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	12/01/2023

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Directions to “ GERTRUDE MUMBA-KAUNDA ” Practice Location

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