Provider Demographics
NPI:1992369490
Name:KIMANI, VERONICAH NJAMBI III (BED)
Entity Type:Individual
Prefix:
First Name:VERONICAH
Middle Name:NJAMBI
Last Name:KIMANI
Suffix:III
Gender:F
Credentials:BED
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:109 OAK ST STE G20
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1492
Mailing Address - Country:US
Mailing Address - Phone:617-658-5611
Mailing Address - Fax:
Practice Address - Street 1:23 PRATT AVE APT 11
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1554
Practice Address - Country:US
Practice Address - Phone:978-319-3744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MACNA-125452376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA065-714-071Medicaid
MAS16162222OtherDRIVING LICENSE
MAS16162222OtherDRIVERS LICENSE