Provider Demographics
NPI:1861207441
Name:KIMFUEMA, BOLAYA (LVN)
Entity type:Individual
Prefix:
First Name:BOLAYA
Middle Name:
Last Name:KIMFUEMA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 GARDEN PATCH WAY
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-8326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:494 BLOSSOM WAY
Practice Address - Street 2:
Practice Address - City:CHERRYLAND
Practice Address - State:CA
Practice Address - Zip Code:94541-1948
Practice Address - Country:US
Practice Address - Phone:510-582-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244919164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse