Provider Demographics
NPI:1073279584
Name:KINYARIRO, MARY WANJIKU (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:WANJIKU
Last Name:KINYARIRO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-2602
Mailing Address - Country:US
Mailing Address - Phone:866-287-2562
Mailing Address - Fax:
Practice Address - Street 1:80 MARKET ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-2602
Practice Address - Country:US
Practice Address - Phone:866-287-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN283550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily