Provider Demographics
NPI:1568772770
Name:KABANGU, NYINDU (LPN)
Entity Type:Individual
Prefix:MR
First Name:NYINDU
Middle Name:
Last Name:KABANGU
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 1:7 HOLBORN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-1313
Mailing Address - Country:US
Mailing Address - Phone:508-215-7920
Mailing Address - Fax:
Practice Address - Street 1:7 HOLBORN ST STE 2
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-1313
Practice Address - Country:US
Practice Address - Phone:508-215-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN62456164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse