Provider Demographics
NPI:1073198594
Name:MUGO, MOSES
Entity Type:Individual
Prefix:
First Name:MOSES
Middle Name:
Last Name:MUGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 NEW CASTER DR
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-1221
Mailing Address - Country:US
Mailing Address - Phone:978-954-8246
Mailing Address - Fax:978-454-3135
Practice Address - Street 1:41 NEW CASTER DR
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-1221
Practice Address - Country:US
Practice Address - Phone:978-954-8246
Practice Address - Fax:978-454-3135
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN66802164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse