Provider Demographics
NPI:1235582859
Name:NJOROGE, GAD KIMAMA (LPN)
Entity Type:Individual
Prefix:MR
First Name:GAD
Middle Name:KIMAMA
Last Name:NJOROGE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 BEAULIEU ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1805
Mailing Address - Country:US
Mailing Address - Phone:978-835-1087
Mailing Address - Fax:
Practice Address - Street 1:81 BEAULIEU ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-1805
Practice Address - Country:US
Practice Address - Phone:978-835-1087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS48990770172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA985962994OtherBLUECROSS BLUESHIELD