Provider Demographics
NPI:1467114967
Name:KAGUNYE, MARY M (LPN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:KAGUNYE
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 1:50 OAK ST EXT APT 301
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1137
Mailing Address - Country:US
Mailing Address - Phone:617-877-9142
Mailing Address - Fax:
Practice Address - Street 1:50 OAK ST EXT APT 301
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1137
Practice Address - Country:US
Practice Address - Phone:617-877-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALP86044164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse