Provider Demographics
NPI:1013489293
Name:GITHU, BENJAMIN (RN)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:GITHU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HERITAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1801
Mailing Address - Country:US
Mailing Address - Phone:603-458-5619
Mailing Address - Fax:
Practice Address - Street 1:21 HERITAGE HILL RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1801
Practice Address - Country:US
Practice Address - Phone:603-458-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2293683163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health