Basic Information
| Provider Information | |||||||||
| NPI: | 1215434691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAMAU | ||||||||
| FirstName: | DORCAS | ||||||||
| MiddleName: | WAMBUI | ||||||||
| NamePrefix: | |||||||||
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| Credential: | ARNP-PMHNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KING | ||||||||
| OtherFirstName: | DORCAS | ||||||||
| OtherMiddleName: | KAMAU | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | JACKSON RECOVERY CENTERS, INC. | ||||||||
| Address2: | 800 5TH STREET | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122342308 | ||||||||
| FaxNumber: | 7122342398 | ||||||||
| Practice Location | |||||||||
| Address1: | JACKSON RECOVERY CENTERS, INC. | ||||||||
| Address2: | 800 5TH STREET | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122342300 | ||||||||
| FaxNumber: | 7122342398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2018 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | G129915 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.