Provider Demographics
NPI:1922483320
Name:MUSOKE, MOUREEN
Entity Type:Individual
Prefix:
First Name:MOUREEN
Middle Name:
Last Name:MUSOKE
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 1:197M BOSTON POST RD W
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1840
Mailing Address - Country:US
Mailing Address - Phone:774-312-5300
Mailing Address - Fax:
Practice Address - Street 1:197M BOSTON POST RD W
Practice Address - Street 2:SUITE 303
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1840
Practice Address - Country:US
Practice Address - Phone:774-312-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker