Provider Demographics
NPI:1508126202
Name:MWALE, BEN
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:MWALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E MOUNTAIN ST
Mailing Address - Street 2:APT 192
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:214 E MOUNTAIN ST
Practice Address - Street 2:APT 192
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1216
Practice Address - Country:US
Practice Address - Phone:508-852-4946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide