Provider Demographics
NPI:1083204606
Name:KAGWANJA, JAMES KANYI
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KANYI
Last Name:KAGWANJA
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 1:9 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1910
Mailing Address - Country:US
Mailing Address - Phone:978-866-1028
Mailing Address - Fax:
Practice Address - Street 1:9 CHARLES ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1910
Practice Address - Country:US
Practice Address - Phone:978-866-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308265163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult