Provider Demographics
NPI:1073134797
Name:AWANDEM, MARGARET FORTOH (LPN)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:FORTOH
Last Name:AWANDEM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CASHMAN RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-5726
Mailing Address - Country:US
Mailing Address - Phone:781-346-1858
Mailing Address - Fax:
Practice Address - Street 1:16 CASHMAN RD
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5726
Practice Address - Country:US
Practice Address - Phone:781-346-2904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN92383164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse