Provider Demographics
NPI:1548430192
Name:NWETBEFUA, DENIS T
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:T
Last Name:NWETBEFUA
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 1:115 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3752
Mailing Address - Country:US
Mailing Address - Phone:617-629-6668
Mailing Address - Fax:617-625-6339
Practice Address - Street 1:167 HOLLAND ST
Practice Address - Street 2:ROOM 133
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2401
Practice Address - Country:US
Practice Address - Phone:617-629-6668
Practice Address - Fax:617-625-6339
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator