Provider Demographics
NPI:1245071489
Name:NAMUBIRU, OLIVIA (LPN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:NAMUBIRU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 STONEHILL DR APT 5A
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3940
Mailing Address - Country:US
Mailing Address - Phone:857-615-0805
Mailing Address - Fax:
Practice Address - Street 1:3 STONEHILL DR APT 5A
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3940
Practice Address - Country:US
Practice Address - Phone:857-615-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN64060164W00000X
MALN640060164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty