Provider Demographics
NPI:1952047466
Name:AJWALA, JEPHINE M (BSN, RN)
Entity Type:Individual
Prefix:
First Name:JEPHINE
Middle Name:M
Last Name:AJWALA
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 C ST
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-2110
Mailing Address - Country:US
Mailing Address - Phone:978-421-7782
Mailing Address - Fax:
Practice Address - Street 1:1 REHABILITATION WAY
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6003
Practice Address - Country:US
Practice Address - Phone:781-935-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-08
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2338846163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse