Provider Demographics
NPI:1457182578
Name:NGIRUWONSANGA, EMANUEL M
Entity type:Individual
Prefix:
First Name:EMANUEL
Middle Name:M
Last Name:NGIRUWONSANGA
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 1:242 MOUNT VERNON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3248
Mailing Address - Country:US
Mailing Address - Phone:781-350-0054
Mailing Address - Fax:
Practice Address - Street 1:242 MOUNT VERNON ST APT 1
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3248
Practice Address - Country:US
Practice Address - Phone:781-350-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN10010491163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health