Provider Demographics
NPI:1619112000
Name:KAKULU, ANDREW D (LPN)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:D
Last Name:KAKULU
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 1:14 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1416
Mailing Address - Country:US
Mailing Address - Phone:617-298-2187
Mailing Address - Fax:
Practice Address - Street 1:14 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1416
Practice Address - Country:US
Practice Address - Phone:617-298-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-13
Last Update Date:2008-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50339164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse