Provider Demographics
NPI:1619732120
Name:LWEBUGA, JACQUILINE NAMATA
Entity Type:Individual
Prefix:
First Name:JACQUILINE
Middle Name:NAMATA
Last Name:LWEBUGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 GORHAM ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-4023
Mailing Address - Country:US
Mailing Address - Phone:617-697-3139
Mailing Address - Fax:
Practice Address - Street 1:658 GORHAM ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4023
Practice Address - Country:US
Practice Address - Phone:617-697-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN65410164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse