Provider Demographics
NPI:1568697027
Name:KAMANDU, MARTIN GITONGA (LPN)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:GITONGA
Last Name:KAMANDU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 WESTFORD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2781
Mailing Address - Country:US
Mailing Address - Phone:617-462-5433
Mailing Address - Fax:978-710-4467
Practice Address - Street 1:1009 WESTFORD ST APT 3
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2781
Practice Address - Country:US
Practice Address - Phone:617-462-5433
Practice Address - Fax:978-710-4467
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA64215164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse