Provider Demographics
NPI:1326569799
Name:NDAHUNGA, JEANNETTE MUKANDORI (LPN)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MUKANDORI
Last Name:NDAHUNGA
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 1:531 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3946
Mailing Address - Country:US
Mailing Address - Phone:781-856-0539
Mailing Address - Fax:
Practice Address - Street 1:531 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3946
Practice Address - Country:US
Practice Address - Phone:781-856-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN85448164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse