Provider Demographics
NPI:1174018253
Name:WAKADILO, STEVE NGOY KIMBA (BSN RN)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:NGOY KIMBA
Last Name:WAKADILO
Suffix:
Gender:M
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 JASMINE DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-4002
Mailing Address - Country:US
Mailing Address - Phone:508-733-2541
Mailing Address - Fax:
Practice Address - Street 1:23 JASMINE DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-4002
Practice Address - Country:US
Practice Address - Phone:508-733-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257139163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse