MEDICARE: KEMUNTO MOKORA

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	4704393156APP22	MI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0027696	OH
3	363LF0000X	Family Nurse Practitioner	0027696	OH
4	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	0027696	OH

General Provider Information

NPI Number	:	1295303386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEMUNTO MOKORA

Provider Business Mailing Address
First Line	:	313 JEFFERSON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1004
Country	:	US
Telephone Number	:	419-720-7883
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 JEFFERSON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1004
Country	:	US
Telephone Number	:	419-720-7883
Fax Number	:

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

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	09/12/2024

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Directions to “ KEMUNTO MOKORA ” Practice Location

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