Provider Demographics
NPI:1073948584
Name:KIRUGU, HANNA WACHEKE
Entity Type:Individual
Prefix:MRS
First Name:HANNA
Middle Name:WACHEKE
Last Name:KIRUGU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SILVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-3537
Mailing Address - Country:US
Mailing Address - Phone:443-416-7204
Mailing Address - Fax:
Practice Address - Street 1:516 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-3537
Practice Address - Country:US
Practice Address - Phone:443-416-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315818-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse