Provider Demographics
NPI:1376329433
Name:NAMBOOZE, PRISCILLA (RN)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:NAMBOOZE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CANNONGATE III
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1950
Mailing Address - Country:US
Mailing Address - Phone:774-239-9253
Mailing Address - Fax:
Practice Address - Street 1:120 CANNONGATE III
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1950
Practice Address - Country:US
Practice Address - Phone:774-239-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH079591-21163W00000X
MARN2370517163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse