Provider Demographics
NPI:1265255277
Name:KANINA, JEFF KANGETHE
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:KANGETHE
Last Name:KANINA
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02303-0217
Mailing Address - Country:US
Mailing Address - Phone:617-642-7594
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 217
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02303-0217
Practice Address - Country:US
Practice Address - Phone:617-642-7594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN88608164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse