Provider Demographics
NPI:1790213296
Name:NYAWIRA, ROSEMARY MUKUNDI (LPN)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:MUKUNDI
Last Name:NYAWIRA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BLUEBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4940
Mailing Address - Country:US
Mailing Address - Phone:781-405-6716
Mailing Address - Fax:
Practice Address - Street 1:4 BLUEBERRY WAY
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4940
Practice Address - Country:US
Practice Address - Phone:781-405-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-27
Last Update Date:2017-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA68970164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse