Provider Demographics
NPI:1366705964
Name:MANYAMA, KAPILI DAUDA (RN)
Entity type:Individual
Prefix:MR
First Name:KAPILI
Middle Name:DAUDA
Last Name:MANYAMA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 NORTHROP AVE APT 203D
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-7578
Mailing Address - Country:US
Mailing Address - Phone:832-512-5377
Mailing Address - Fax:
Practice Address - Street 1:2341 NORTHROP AVE APT 203D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-7578
Practice Address - Country:US
Practice Address - Phone:832-512-5377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA761809163W00000X
TX720688163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse