Provider Demographics
NPI:1780005330
Name:REGISTERED NURSE AGENCY
Entity Type:Organization
Organization Name:REGISTERED NURSE AGENCY
Other - Org Name:NA
Other - Org Type:Other Name
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOSAYABA
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:IZEDONMWEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-275-9385
Mailing Address - Street 1:580 SHAWMUT AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1775
Mailing Address - Country:US
Mailing Address - Phone:617-275-9385
Mailing Address - Fax:
Practice Address - Street 1:580 SHAWMUT AVE
Practice Address - Street 2:APT 1A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1775
Practice Address - Country:US
Practice Address - Phone:617-275-9385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2268310313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility