Provider Demographics
NPI:1023715786
Name:MOKO, SAMUEL MBWAYE
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MBWAYE
Last Name:MOKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BOWDOIN ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-2136
Mailing Address - Country:US
Mailing Address - Phone:781-526-7051
Mailing Address - Fax:781-202-4058
Practice Address - Street 1:122 BOWDOIN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2136
Practice Address - Country:US
Practice Address - Phone:781-526-7051
Practice Address - Fax:781-202-4058
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care