Provider Demographics
NPI:1255196317
Name:REX, PRONA NAKUBULWA (BSN)
Entity type:Individual
Prefix:
First Name:PRONA
Middle Name:NAKUBULWA
Last Name:REX
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 KENNEDY DR APT 211
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3444
Mailing Address - Country:US
Mailing Address - Phone:781-475-7844
Mailing Address - Fax:
Practice Address - Street 1:181 KENNEDY DR APT 211
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3444
Practice Address - Country:US
Practice Address - Phone:781-475-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2385960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine