Provider Demographics
NPI:1659854545
Name:TAMUKEDDE, DICKENS (LPN)
Entity Type:Individual
Prefix:MR
First Name:DICKENS
Middle Name:
Last Name:TAMUKEDDE
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 1:82 BRICK KILN RD UNIT 10202
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3245
Mailing Address - Country:US
Mailing Address - Phone:617-792-9788
Mailing Address - Fax:
Practice Address - Street 1:82 BRICK KILN RD UNIT 10202
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3245
Practice Address - Country:US
Practice Address - Phone:617-792-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN93609164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty