Provider Demographics
NPI:1780205922
Name:WAWERU, JOSEPH M (CEO)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:WAWERU
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHESTNUT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-9302
Mailing Address - Country:US
Mailing Address - Phone:603-943-4105
Mailing Address - Fax:
Practice Address - Street 1:1 CHESTNUT ST STE 201
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-9302
Practice Address - Country:US
Practice Address - Phone:603-943-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH013217-22164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse