Provider Demographics
NPI:1003521212
Name:KAIRU, KENNEY (DNP,MBA)
Entity Type:Individual
Prefix:DR
First Name:KENNEY
Middle Name:
Last Name:KAIRU
Suffix:
Gender:M
Credentials:DNP,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-2849
Mailing Address - Country:US
Mailing Address - Phone:774-420-8144
Mailing Address - Fax:
Practice Address - Street 1:101 PLEASANT ST STE 209
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-3213
Practice Address - Country:US
Practice Address - Phone:774-420-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281253163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse