Provider Demographics
NPI:1245620020
Name:MUTEMBEI, FRIDAH (LPN)
Entity Type:Individual
Prefix:
First Name:FRIDAH
Middle Name:
Last Name:MUTEMBEI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ROBBINS AVE UNIT 87
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-5274
Mailing Address - Country:US
Mailing Address - Phone:978-421-5149
Mailing Address - Fax:
Practice Address - Street 1:35 ROBBINS AVE UNIT 87
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-5274
Practice Address - Country:US
Practice Address - Phone:978-421-5149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN85559164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse