Provider Demographics
NPI:1407376643
Name:NAKANWAGI, CISSY D (RN)
Entity Type:Individual
Prefix:MS
First Name:CISSY
Middle Name:D
Last Name:NAKANWAGI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7 TOTMAN DR APT 9
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-5455
Mailing Address - Country:US
Mailing Address - Phone:781-696-9237
Mailing Address - Fax:
Practice Address - Street 1:7 TOTMAN DR # 9
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-696-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235060163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS32767018OtherDRIVER'S LICENSE
MA235060OtherRN LICENSE NUMBER
MA235060OtherRNLICENSE NUMBER