Provider Demographics
NPI:1528363645
Name:KIONGERA, ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KIONGERA
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 1:439 S UNION ST STE 2
Mailing Address - Street 2:107
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-2844
Mailing Address - Country:US
Mailing Address - Phone:978-794-1158
Mailing Address - Fax:978-794-1507
Practice Address - Street 1:439 S UNION ST STE 2
Practice Address - Street 2:107
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2844
Practice Address - Country:US
Practice Address - Phone:978-794-1158
Practice Address - Fax:978-794-1507
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2259105163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse